Healthcare Provider Details

I. General information

NPI: 1760703615
Provider Name (Legal Business Name): DAWN T. HEFFERNAN RN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 06/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 MAPLE STREET HOLYOKE HEALTH CENTER, INC
HOLYOKE MA
01041-6260
US

IV. Provider business mailing address

230 MAPLE STREET HOLYOKE HEALTH CENTER, INC
HOLYOKE MA
01041-6260
US

V. Phone/Fax

Practice location:
  • Phone: 413-420-2200
  • Fax:
Mailing address:
  • Phone: 413-420-2144
  • Fax: 413-540-0957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN195616
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: