Provider Demographics
NPI:1821706219
Name:CROFUTT, HEATHER RENAE
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:RENAE
Last Name:CROFUTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SHELTON ST
Mailing Address - Street 2:
Mailing Address - City:CHADRON
Mailing Address - State:NE
Mailing Address - Zip Code:69337-2312
Mailing Address - Country:US
Mailing Address - Phone:308-747-2401
Mailing Address - Fax:
Practice Address - Street 1:300 SHELTON ST
Practice Address - Street 2:
Practice Address - City:CHADRON
Practice Address - State:NE
Practice Address - Zip Code:69337-2312
Practice Address - Country:US
Practice Address - Phone:308-747-2401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator