Provider Demographics
NPI:1508833153
Name:HEFFEL, CHERI LYNN (NP)
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:LYNN
Last Name:HEFFEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9951 WEST RD
Mailing Address - Street 2:
Mailing Address - City:REDWOOD VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95470
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:240 N CLOVERDALE BLVD
Practice Address - Street 2:COPPER TOWERS FAMILY MEDICAL CENTER
Practice Address - City:CLOVERDALE
Practice Address - State:CA
Practice Address - Zip Code:95425
Practice Address - Country:US
Practice Address - Phone:707-894-4229
Practice Address - Fax:707-894-1063
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8158363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MH0547868OtherDEA
P90891Medicare UPIN
ZZZ26343ZMedicare ID - Type Unspecified