Healthcare Provider Details

I. General information

NPI: 1629293378
Provider Name (Legal Business Name): HEATHER APPRIL HENTO DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 06/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 PACIFIC AVE #1
TACOMA WA
98408-7050
US

IV. Provider business mailing address

7808 PACIFIC AVE SUITE 1
TACOMA WA
98408-7039
US

V. Phone/Fax

Practice location:
  • Phone: 253-473-6436
  • Fax:
Mailing address:
  • Phone: 586-791-0251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO00000828
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901002183
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: