Healthcare Provider Details

I. General information

NPI: 1427276088
Provider Name (Legal Business Name): LARA HEFNER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 06/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 GLENDON CT #360
DUBLIN OH
43017
US

IV. Provider business mailing address

PO BOX 1918
POWELL OH
43065-1918
US

V. Phone/Fax

Practice location:
  • Phone: 614-888-8237
  • Fax: 614-888-8256
Mailing address:
  • Phone: 614-888-8237
  • Fax: 614-888-8256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN223457
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: