Provider Demographics
NPI:1356380240
Name:HEFFELFINGER, BRANDI LYNN (CNP)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:LYNN
Last Name:HEFFELFINGER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:
Other - Last Name:STEFFEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:3358 RIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3118
Mailing Address - Country:US
Mailing Address - Phone:330-665-1455
Mailing Address - Fax:
Practice Address - Street 1:3358 RIDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3118
Practice Address - Country:US
Practice Address - Phone:330-665-1455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-07499363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000342104OtherANTHEM
OH2470571Medicaid
OHSTNP14592Medicare ID - Type Unspecified
OH000000342104OtherANTHEM