Healthcare Provider Details

I. General information

NPI: 1932784402
Provider Name (Legal Business Name): JACQUELINE HEFFNER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 S RAILROAD ST
TAMAQUA PA
18252-1927
US

IV. Provider business mailing address

77 S COMMERCE WAY
BETHLEHEM PA
18017-8891
US

V. Phone/Fax

Practice location:
  • Phone: 570-645-1950
  • Fax:
Mailing address:
  • Phone: 148-452-6289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP022814
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: