Provider Demographics
NPI:1952128597
Name:ELEM, HEAVEN'LI
Entity type:Individual
Prefix:
First Name:HEAVEN'LI
Middle Name:
Last Name:ELEM
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 1:8982 N MAIN ST APT A
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:OH
Mailing Address - Zip Code:44288-1064
Mailing Address - Country:US
Mailing Address - Phone:215-680-0307
Mailing Address - Fax:
Practice Address - Street 1:8982 N MAIN ST APT A
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:OH
Practice Address - Zip Code:44288-1064
Practice Address - Country:US
Practice Address - Phone:215-680-0307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider