Healthcare Provider Details

I. General information

NPI: 1275298564
Provider Name (Legal Business Name): CASEY L HECK HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 W. 7TH ST.
GRAND ISLAND NE
68801-4221
US

IV. Provider business mailing address

721 W. 7TH ST.
GRAND ISLAND NE
68801-4221
US

V. Phone/Fax

Practice location:
  • Phone: 308-682-9169
  • Fax:
Mailing address:
  • Phone: 308-682-9169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number852
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: