Provider Demographics
NPI:1780084376
Name:HEFFERNAN, DOROTHY (RN)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:HEFFERNAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:ALICE
Other - Last Name:DOSTAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3300 N 60TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-3402
Mailing Address - Country:US
Mailing Address - Phone:402-829-9267
Mailing Address - Fax:
Practice Address - Street 1:3300 N 60TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-3402
Practice Address - Country:US
Practice Address - Phone:402-829-9267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA105466163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47037661200Medicaid
NE10025225100Medicaid