Provider Demographics
NPI:1932700309
Name:MERSHON, HEATHER (LPN)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:MERSHON
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 1:1535 E HICKORY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-9475
Mailing Address - Country:US
Mailing Address - Phone:937-896-7513
Mailing Address - Fax:
Practice Address - Street 1:1535 E HICKORY GROVE RD
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-9475
Practice Address - Country:US
Practice Address - Phone:937-896-7513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.176134.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse