Provider Demographics
NPI:1649045360
Name:HECKELSBERG, RAINA
Entity type:Individual
Prefix:
First Name:RAINA
Middle Name:
Last Name:HECKELSBERG
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 1:8070 E SR 46
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:IN
Mailing Address - Zip Code:47833
Mailing Address - Country:US
Mailing Address - Phone:812-691-6242
Mailing Address - Fax:
Practice Address - Street 1:8070 E SR 46
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:IN
Practice Address - Zip Code:47833
Practice Address - Country:US
Practice Address - Phone:812-691-6242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor