Provider Demographics
NPI:1114504883
Name:HEFNER, ISABEL MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ISABEL
Middle Name:MARIE
Last Name:HEFNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ISABEL
Other - Middle Name:MARIE
Other - Last Name:HENDRICKSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:601 RIVER BEND RD
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-2713
Mailing Address - Country:US
Mailing Address - Phone:703-969-3281
Mailing Address - Fax:
Practice Address - Street 1:501 6TH AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4634
Practice Address - Country:US
Practice Address - Phone:727-767-4601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program