Provider Demographics
NPI:1376146001
Name:PENCE, HEATHER JO
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:JO
Last Name:PENCE
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 1:711 LAMBERT DR
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-5424
Mailing Address - Country:US
Mailing Address - Phone:937-418-2298
Mailing Address - Fax:937-916-3206
Practice Address - Street 1:711 LAMBERT DR
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-5424
Practice Address - Country:US
Practice Address - Phone:937-418-2298
Practice Address - Fax:937-916-3206
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty