Provider Demographics
NPI:1235737297
Name:HEVENER, MINERVA JEAN
Entity Type:Individual
Prefix:
First Name:MINERVA
Middle Name:JEAN
Last Name:HEVENER
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 1:27 MIDWAY LOOP
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-1373
Mailing Address - Country:US
Mailing Address - Phone:304-636-5252
Mailing Address - Fax:304-591-4521
Practice Address - Street 1:27 MIDWAY LOOP
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-1373
Practice Address - Country:US
Practice Address - Phone:304-636-5252
Practice Address - Fax:304-591-4521
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty