Healthcare Provider Details

I. General information

NPI: 1922594514
Provider Name (Legal Business Name): HEATHER JO HUFFMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2018
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N EWING ST
LANCASTER OH
43130
US

IV. Provider business mailing address

20515 STATE ROUTE 664 S
LOGAN OH
43138-8526
US

V. Phone/Fax

Practice location:
  • Phone: 740-687-8000
  • Fax:
Mailing address:
  • Phone: 740-279-9580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.297246
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.023349
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: