Healthcare Provider Details

I. General information

NPI: 1558644831
Provider Name (Legal Business Name): VICTORIA M HEFNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SCHOOL ST
BOLIVAR NY
14715-1235
US

IV. Provider business mailing address

100 SCHOOL ST
BOLIVAR NY
14715-1235
US

V. Phone/Fax

Practice location:
  • Phone: 585-928-2561
  • Fax: 585-928-1368
Mailing address:
  • Phone: 585-928-2561
  • Fax: 585-928-1368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number319286
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: