Provider Demographics
NPI:1508453028
Name:HIETT, ANNA MAE
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MAE
Last Name:HIETT
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:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:RIDGELEY
Mailing Address - State:WV
Mailing Address - Zip Code:26753-0057
Mailing Address - Country:US
Mailing Address - Phone:301-876-1613
Mailing Address - Fax:
Practice Address - Street 1:177 BLOCKER STREET
Practice Address - Street 2:
Practice Address - City:RIDGELEY
Practice Address - State:WV
Practice Address - Zip Code:26753-0057
Practice Address - Country:US
Practice Address - Phone:301-876-1613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant