Healthcare Provider Details

I. General information

NPI: 1497029094
Provider Name (Legal Business Name): DEBRA LYNNE HEVERLING RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2012
Last Update Date: 02/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 ROBINSON ST SUITE 100
POTTSTOWN PA
19464-6421
US

IV. Provider business mailing address

4003 ELAND DOWNE
PHOENIXVILLE PA
19460-1317
US

V. Phone/Fax

Practice location:
  • Phone: 610-326-9460
  • Fax:
Mailing address:
  • Phone: 484-530-5961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN004601
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: