Provider Demographics
NPI:1083941900
Name:HETTINGER, CASI (LPN)
Entity Type:Individual
Prefix:
First Name:CASI
Middle Name:
Last Name:HETTINGER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 352
Mailing Address - Street 2:16295 STATE ROUTE 180
Mailing Address - City:LAURELVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43135
Mailing Address - Country:US
Mailing Address - Phone:740-497-9082
Mailing Address - Fax:
Practice Address - Street 1:16295 STATE ROUTE 180
Practice Address - Street 2:
Practice Address - City:LAURELVILLE
Practice Address - State:OH
Practice Address - Zip Code:43135
Practice Address - Country:US
Practice Address - Phone:740-497-9082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.128737164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse