Provider Demographics
NPI:1497269831
Name:DRAKE, HEIDILYN MARIE (RN)
Entity Type:Individual
Prefix:
First Name:HEIDILYN
Middle Name:MARIE
Last Name:DRAKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 VENANGO ST
Mailing Address - Street 2:
Mailing Address - City:CYGNET
Mailing Address - State:OH
Mailing Address - Zip Code:43413-9803
Mailing Address - Country:US
Mailing Address - Phone:567-207-1269
Mailing Address - Fax:
Practice Address - Street 1:1033 DEVLAC GRV
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-4501
Practice Address - Country:US
Practice Address - Phone:419-352-5561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN443922163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse