Provider Demographics
NPI:1760703615
Name:HEFFERNAN, DAWN T (RN, CDE)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:T
Last Name:HEFFERNAN
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 MAPLE STREET
Mailing Address - Street 2:HOLYOKE HEALTH CENTER, INC
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01041-6260
Mailing Address - Country:US
Mailing Address - Phone:413-420-2144
Mailing Address - Fax:413-540-0957
Practice Address - Street 1:230 MAPLE STREET
Practice Address - Street 2:HOLYOKE HEALTH CENTER, INC
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01041-6260
Practice Address - Country:US
Practice Address - Phone:413-420-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN195616163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse