Provider Demographics
NPI:1114290327
Name:HETTINGER, NATALIE L (LPN)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:L
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 1:11561 MURLETTE RD SW
Mailing Address - Street 2:
Mailing Address - City:STOUTSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43154-9723
Mailing Address - Country:US
Mailing Address - Phone:740-497-3202
Mailing Address - Fax:
Practice Address - Street 1:11561 MURLETTE RD SW
Practice Address - Street 2:
Practice Address - City:STOUTSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43154-9723
Practice Address - Country:US
Practice Address - Phone:740-497-3202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN130653 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse