Provider Demographics
NPI:1841888732
Name:HORNE, HEATHER R
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:R
Last Name:HORNE
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:PO BOX 572
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:OH
Mailing Address - Zip Code:44050-0572
Mailing Address - Country:US
Mailing Address - Phone:440-309-8107
Mailing Address - Fax:
Practice Address - Street 1:203 E PROSPECT ST
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:OH
Practice Address - Zip Code:44050
Practice Address - Country:US
Practice Address - Phone:440-309-8107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider