Provider Demographics
NPI:1417566548
Name:RATHOD, HEENABEN (FNP)
Entity Type:Individual
Prefix:MS
First Name:HEENABEN
Middle Name:
Last Name:RATHOD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12410 TOEPPERWEIN RD
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3230
Mailing Address - Country:US
Mailing Address - Phone:210-742-6555
Mailing Address - Fax:224-623-0079
Practice Address - Street 1:12410 TOEPPERWEIN RD
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3230
Practice Address - Country:US
Practice Address - Phone:210-742-6555
Practice Address - Fax:224-623-0079
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX979120163W00000X
IL041.458859163W00000X
TX1010971363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse