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General NPI Number Information
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NPI Number | 1114416294
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Entity Type | Individual
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Provider Name | KATHLEEN RAE HEVENER
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Gender | Female
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Dates
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Enumeration Date | 05/04/2018
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Last Update Date | 05/04/2018
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Provider Practice Location Address
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Address Line | 17 N CHAMPION ST
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City | YOUNGSTOWN
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State | OH
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Zip | 44503-1636
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Country | US
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Telephone | 330-480-5656
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Fax |
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Provider Business Mailing Address
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Address Line | 7349 WEST BLVD APT C
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City | YOUNGSTOWN
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State | OH
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Zip | 44512-5272
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Country | US
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Telephone | 330-501-3132
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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 | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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