Healthcare Provider Details

I. General information

NPI: 1609906304
Provider Name (Legal Business Name): ALLEN J HEFNER JR. RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 ISAAC STREETS DR SUITE 122
OREGON OH
43616-3291
US

IV. Provider business mailing address

1050 ISAAC STREETS DR SUITE 122
OREGON OH
43616-3291
US

V. Phone/Fax

Practice location:
  • Phone: 419-696-5511
  • Fax: 419-696-1750
Mailing address:
  • Phone: 419-696-5511
  • Fax: 419-696-1750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License NumberRN. 195142
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: