Healthcare Provider Details

I. General information

NPI: 1942530373
Provider Name (Legal Business Name): BRENDA HEFFNER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2010
Last Update Date: 04/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 UNION AVE STE 1007
MEMPHIS TN
38104-3664
US

IV. Provider business mailing address

161 WASHINGTON STREET, 14TH FL EIGHT TOWER BRIDGE, SUITE 1400
CONSHOHOCKEN PA
19428
US

V. Phone/Fax

Practice location:
  • Phone: 901-276-2357
  • Fax:
Mailing address:
  • Phone: 484-351-3206
  • Fax: 484-450-2617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14645
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: