Healthcare Provider Details

I. General information

NPI: 1215289426
Provider Name (Legal Business Name): PHOEBE M HEFFRON NP, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 09/11/2025
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 SHREWSBURY ST STE 105B
WORCESTER MA
01604-4652
US

IV. Provider business mailing address

218 SHREWSBURY ST STE 105B
WORCESTER MA
01604-4652
US

V. Phone/Fax

Practice location:
  • Phone: 508-203-7797
  • Fax:
Mailing address:
  • Phone: 978-452-1666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN2260049
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: