Provider Demographics
NPI:1558644831
Name:HEFNER, VICTORIA M
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:M
Last Name:HEFNER
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 1:100 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:NY
Mailing Address - Zip Code:14715-1235
Mailing Address - Country:US
Mailing Address - Phone:585-928-2561
Mailing Address - Fax:585-928-1368
Practice Address - Street 1:100 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:NY
Practice Address - Zip Code:14715-1235
Practice Address - Country:US
Practice Address - Phone:585-928-2561
Practice Address - Fax:585-928-1368
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY319286163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool