Provider Demographics
NPI:1255939427
Name:HARSHAW, HEATHER L
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:HARSHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:L
Other - Last Name:WALTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:763 S HAGUE AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-2301
Mailing Address - Country:US
Mailing Address - Phone:614-571-9809
Mailing Address - Fax:
Practice Address - Street 1:763 S HAGUE AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-2301
Practice Address - Country:US
Practice Address - Phone:614-571-9809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-11
Last Update Date:2020-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No347C00000XTransportation ServicesPrivate Vehicle