Healthcare Provider Details

I. General information

NPI: 1275203036
Provider Name (Legal Business Name): ERIC KENTON HEUGEL RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3663 WASHINGTON PARK BLVD
NEWBURGH HEIGHTS OH
44105-3177
US

IV. Provider business mailing address

3663 WASHINGTON PARK BLVD
NEWBURGH HEIGHTS OH
44105-3177
US

V. Phone/Fax

Practice location:
  • Phone: 216-773-2325
  • Fax:
Mailing address:
  • Phone: 216-773-2325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number420874
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: