Individual
ELIZABETH HEVERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
800 UNIVERSITY DR, MARYVILLE, MO 64468-6015
(914) 715-0128
Mailing address
324 E 3RD ST, APT #3, MARYVILLE, MO 64468-3232
(914) 715-0128
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2014023823
MO
Other
Enumeration date
04/30/2015
Last updated
04/30/2015
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