Provider Demographics
NPI:1508492000
Name:JEFFERY, HEATHER DAWN (RN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:DAWN
Last Name:JEFFERY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:DAWN
Other - Last Name:MARION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:62783 BARBARA AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-8764
Mailing Address - Country:US
Mailing Address - Phone:740-255-0215
Mailing Address - Fax:
Practice Address - Street 1:62783 BARBARA AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-8764
Practice Address - Country:US
Practice Address - Phone:740-255-0215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.304445163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health