MEDICARE: MISS ERICA HEFNER R.D.

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
1	133VN1006X	Metabolic Nutrition Registered Dietitian	5501-32438	TX

General Provider Information

NPI Number	:	1760879530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ERICA HEFNER R.D.

Provider Business Mailing Address
First Line	:	3117 SHARPVIEW LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-6057
Country	:	US
Telephone Number	:	214-923-2884
Fax Number	:

Provider Business Practice Location Address
First Line	:	3117 SHARPVIEW LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-6057
Country	:	US
Telephone Number	:	214-923-2884
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2015
Last Update Date	:	04/20/2015

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