Provider Demographics
NPI:1376859447
Name:ACORD, HEATHER CHRISTENE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:CHRISTENE
Last Name:ACORD
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 1:29245 FAIRVIEW RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-9494
Mailing Address - Country:US
Mailing Address - Phone:740-380-3612
Mailing Address - Fax:740-380-3612
Practice Address - Street 1:29245 FAIRVIEW RIDGE RD
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-9494
Practice Address - Country:US
Practice Address - Phone:740-380-3612
Practice Address - Fax:740-380-3612
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH140287164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse