Provider Demographics
NPI:1790199115
Name:ALFLEN, HEIDI (NP)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:ALFLEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 PLEASANT VIEW LN
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:OH
Mailing Address - Zip Code:44234-9673
Mailing Address - Country:US
Mailing Address - Phone:330-980-4144
Mailing Address - Fax:
Practice Address - Street 1:185 FAIRLAWN AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-2041
Practice Address - Country:US
Practice Address - Phone:330-980-4144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHX363LF0000X
OHCOA-16307363LA2100X
OHCOA 16307363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care