Provider Demographics
NPI:1942777487
Name:JENNINGS, HEATHER F (CG)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:F
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:CG
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:F
Other - Last Name:MEDDAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CG
Mailing Address - Street 1:165 E HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-2629
Mailing Address - Country:US
Mailing Address - Phone:509-684-4597
Mailing Address - Fax:509-684-5286
Practice Address - Street 1:165 E HAWTHORNE AVE
Practice Address - Street 2:
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-2629
Practice Address - Country:US
Practice Address - Phone:509-684-4597
Practice Address - Fax:509-684-5286
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60803732376K00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No376K00000XNursing Service Related ProvidersNurse's Aide