Provider Demographics
NPI:1790832350
Name:LANIGAN, HEATHER DAWN (LPN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:DAWN
Last Name:LANIGAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7079 COLUMBUS RD.
Mailing Address - Street 2:
Mailing Address - City:MOUNT LIBERTY
Mailing Address - State:OH
Mailing Address - Zip Code:43048
Mailing Address - Country:US
Mailing Address - Phone:740-625-4049
Mailing Address - Fax:
Practice Address - Street 1:7079 COLUMBUS RD.
Practice Address - Street 2:
Practice Address - City:MOUNT LIBERTY
Practice Address - State:OH
Practice Address - Zip Code:43048
Practice Address - Country:US
Practice Address - Phone:740-625-4049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 105709164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2431747Medicaid