Healthcare Provider Details

I. General information

NPI: 1780084376
Provider Name (Legal Business Name): DOROTHY HEFFERNAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DOROTHY ALICE DOSTAL RN

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 N 60TH ST
OMAHA NE
68104-3402
US

IV. Provider business mailing address

3300 N 60TH ST
OMAHA NE
68104-3402
US

V. Phone/Fax

Practice location:
  • Phone: 402-829-9267
  • Fax:
Mailing address:
  • Phone: 402-829-9267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number105466
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: