Provider Demographics
NPI:1205233038
Name:HEFFNER GIBSON, LORI (CPM, LM, MBC)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:HEFFNER GIBSON
Suffix:
Gender:F
Credentials:CPM, LM, MBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4694 WESTWIND DR
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-8185
Mailing Address - Country:US
Mailing Address - Phone:704-607-6776
Mailing Address - Fax:253-595-0866
Practice Address - Street 1:4694 WESTWIND DR
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-8185
Practice Address - Country:US
Practice Address - Phone:704-607-6776
Practice Address - Fax:253-595-0866
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLMW-0063176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife