Provider Demographics
NPI:1831426063
Name:HEUBERGER, GRETCHEN DANIELLE (LPN)
Entity type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:DANIELLE
Last Name:HEUBERGER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 GILMORE ST
Mailing Address - Street 2:
Mailing Address - City:KENTON
Mailing Address - State:OH
Mailing Address - Zip Code:43326-1608
Mailing Address - Country:US
Mailing Address - Phone:419-674-3121
Mailing Address - Fax:
Practice Address - Street 1:418 GILMORE ST
Practice Address - Street 2:
Practice Address - City:KENTON
Practice Address - State:OH
Practice Address - Zip Code:43326-1608
Practice Address - Country:US
Practice Address - Phone:419-674-3121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.136448-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse