Provider Demographics
NPI:1679644850
Name:DAWN HEFNER
Entity Type:Organization
Organization Name:DAWN HEFNER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HEFNER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:419-443-1405
Mailing Address - Street 1:1215 E COUNTY ROAD 16
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-9338
Mailing Address - Country:US
Mailing Address - Phone:419-443-1405
Mailing Address - Fax:
Practice Address - Street 1:758 W TOWNSHIP ROAD 1190
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-9116
Practice Address - Country:US
Practice Address - Phone:419-443-8752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN110172251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2541360OtherPROVIDER NUMBER