Healthcare Provider Details

I. General information

NPI: 1104830215
Provider Name (Legal Business Name): VANESSA RENEE HECKMAN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 EAKIN RD STE 100
COLUMBUS OH
43223-3572
US

IV. Provider business mailing address

PO BOX 745254
ATLANTA GA
30374-5254
US

V. Phone/Fax

Practice location:
  • Phone: 614-300-9001
  • Fax: 614-675-7824
Mailing address:
  • Phone: 312-733-9730
  • Fax: 773-866-8014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.07147-NP
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.07147
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN.258851
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: