Provider Demographics
NPI:1760630149
Name:WAGNER-HEFFNER, DIANE PENNY (MA)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:PENNY
Last Name:WAGNER-HEFFNER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 TIMBER TRL
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-2392
Mailing Address - Country:US
Mailing Address - Phone:734-355-3899
Mailing Address - Fax:734-222-1877
Practice Address - Street 1:1810 TIMBER TRL
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-2392
Practice Address - Country:US
Practice Address - Phone:734-355-3899
Practice Address - Fax:734-222-1877
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator