Provider Demographics
NPI:1891081261
Name:HEAVILON, PENNY SUE (RVT, RT(R)(M))
Entity Type:Individual
Prefix:MS
First Name:PENNY
Middle Name:SUE
Last Name:HEAVILON
Suffix:
Gender:F
Credentials:RVT, RT(R)(M)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 CHARNWOOD PKWY
Mailing Address - Street 2:
Mailing Address - City:BEECH GROVE
Mailing Address - State:IN
Mailing Address - Zip Code:46107-3307
Mailing Address - Country:US
Mailing Address - Phone:317-780-8935
Mailing Address - Fax:
Practice Address - Street 1:1003 CHARNWOOD PKWY
Practice Address - Street 2:
Practice Address - City:BEECH GROVE
Practice Address - State:IN
Practice Address - Zip Code:46107-3307
Practice Address - Country:US
Practice Address - Phone:317-780-8935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular Specialist