Healthcare Provider Details

I. General information

NPI: 1508492000
Provider Name (Legal Business Name): HEATHER DAWN JEFFERY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER DAWN MARION RN

II. Dates (important events)

Enumeration Date: 03/16/2020
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62783 BARBARA AVE
CAMBRIDGE OH
43725-8764
US

IV. Provider business mailing address

62783 BARBARA AVE
CAMBRIDGE OH
43725-8764
US

V. Phone/Fax

Practice location:
  • Phone: 740-255-0215
  • Fax:
Mailing address:
  • Phone: 740-255-0215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN.304445
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: