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General NPI Number Information
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NPI Number | 1083969984
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Entity Type | Individual
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Provider Name | MICHELE HEDDERMAN CNP
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Gender | Female
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Dates
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Enumeration Date | 07/17/2012
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Last Update Date | 07/17/2012
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Provider Practice Location Address
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Address Line | 793 W STATE ST
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City | COLUMBUS
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State | OH
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Zip | 43222-1551
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Country | US
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Telephone | 330-221-5017
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Fax |
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Provider Business Mailing Address
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Address Line | 5279 WOODBRIDGE AVE
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City | POWELL
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State | OH
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Zip | 43065-8603
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Country | US
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Telephone | 614-336-1753
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | COA.05281-NP
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License Number State | OH
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