Provider Demographics
NPI:1356164636
Name:WASHBURN, HEIDI L
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:L
Last Name:WASHBURN
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 1:411 N PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:OH
Mailing Address - Zip Code:45843-1045
Mailing Address - Country:US
Mailing Address - Phone:419-306-2734
Mailing Address - Fax:
Practice Address - Street 1:411 N PATTERSON ST
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:OH
Practice Address - Zip Code:45843-1045
Practice Address - Country:US
Practice Address - Phone:419-306-2734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide