Healthcare Provider Details

I. General information

NPI: 1376405274
Provider Name (Legal Business Name): ELLYN MARIE HEFFLEFINGER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2025
Last Update Date: 11/29/2025
Certification Date: 11/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 N 11TH ST
RICHMOND VA
23298-5024
US

IV. Provider business mailing address

715 N 24TH ST
RICHMOND VA
23223-6407
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-9000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001299367
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: