Provider Demographics
NPI:1265219794
Name:HEFFTA, ANDREA JO
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:JO
Last Name:HEFFTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11571 65TH ST NE
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:ND
Mailing Address - Zip Code:58210-9412
Mailing Address - Country:US
Mailing Address - Phone:218-329-6841
Mailing Address - Fax:
Practice Address - Street 1:11571 65TH ST NE
Practice Address - Street 2:
Practice Address - City:ADAMS
Practice Address - State:ND
Practice Address - Zip Code:58210-9412
Practice Address - Country:US
Practice Address - Phone:218-329-6841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant