Healthcare Provider Details

I. General information

NPI: 1619454238
Provider Name (Legal Business Name): BRENDA HEIDINGER OCPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W FEDERAL ST STE 201
YOUNGSTOWN OH
44503-1206
US

IV. Provider business mailing address

222 W FEDERAL ST STE 201
YOUNGSTOWN OH
44503-1206
US

V. Phone/Fax

Practice location:
  • Phone: 330-746-2959
  • Fax: 330-746-1052
Mailing address:
  • Phone: 330-746-2959
  • Fax: 330-746-1052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number131005
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: