Provider Demographics
NPI:1760196588
Name:HEFFNER, ANGELA (CPM, LM)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:HEFFNER
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 RIDGE RD STE 5
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-5830
Mailing Address - Country:US
Mailing Address - Phone:949-373-6140
Mailing Address - Fax:
Practice Address - Street 1:3021 RIDGE RD STE 5
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-5830
Practice Address - Country:US
Practice Address - Phone:949-373-6140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99504176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife