Healthcare Provider Details

I. General information

NPI: 1033137450
Provider Name (Legal Business Name): MICHELLE LYNN HEFFRON AHCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11155 DUNN RD
SAINT LOUIS MO
63136-6150
US

IV. Provider business mailing address

11155 DUNN RD STE 204 STE 204
SAINT LOUIS MO
63136-6150
US

V. Phone/Fax

Practice location:
  • Phone: 314-355-3003
  • Fax: 314-355-0515
Mailing address:
  • Phone: 314-355-3033
  • Fax: 314-355-0515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License Number124811
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: