Healthcare Provider Details

I. General information

NPI: 1235252875
Provider Name (Legal Business Name): MS. STEPHANIE GABRIELLA HEFLIN IV
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 VISTA CIR APT #49
ABERDEEN OH
45101-9542
US

IV. Provider business mailing address

1890 VISTA CIR APT #49
ABERDEEN OH
45101-9542
US

V. Phone/Fax

Practice location:
  • Phone: 937-795-0470
  • Fax:
Mailing address:
  • Phone: 937-795-0470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number2606719
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: