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NPI Code Detail

MEDICARE: MAKAYLA ANN HEAVER

MEDICARE: MAKAYLA ANN HEAVER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical Nurse36249WV

General Provider Information

NPI Number : 1023731122
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAKAYLA ANN HEAVER
Provider Business Mailing Address
First Line : 181 FOXVIEW LN
Second Line :
City : BOB WHITE
State : WV
Zip : 25028-9010
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 298 TRICORN RD
Second Line :
City : DANVILLE
State : WV
Zip : 25053-7148
Country : US
Telephone Number : 304-369-1385
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2022
Last Update Date : 09/22/2022

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Directions to “ MAKAYLA ANN HEAVER ” Practice Location

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