Provider Demographics
NPI:1083214910
Name:HECKATHORN, JENNA RAE
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:RAE
Last Name:HECKATHORN
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 1:837 DAN AVE
Mailing Address - Street 2:
Mailing Address - City:CANAL FULTON
Mailing Address - State:OH
Mailing Address - Zip Code:44614-8802
Mailing Address - Country:US
Mailing Address - Phone:330-703-4619
Mailing Address - Fax:
Practice Address - Street 1:837 DAN AVE
Practice Address - Street 2:
Practice Address - City:CANAL FULTON
Practice Address - State:OH
Practice Address - Zip Code:44614-8802
Practice Address - Country:US
Practice Address - Phone:330-703-4619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide