Provider Demographics
NPI:1073118287
Name:HECK, TREVA
Entity Type:Individual
Prefix:
First Name:TREVA
Middle Name:
Last Name:HECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 130TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:PARK RIVER
Mailing Address - State:ND
Mailing Address - Zip Code:58270-9306
Mailing Address - Country:US
Mailing Address - Phone:701-331-0579
Mailing Address - Fax:
Practice Address - Street 1:6901 130TH AVE NE
Practice Address - Street 2:
Practice Address - City:PARK RIVER
Practice Address - State:ND
Practice Address - Zip Code:58270-9306
Practice Address - Country:US
Practice Address - Phone:701-331-0579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant