Organization
EXTENDED NP CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTIN ELIZABETH HEENAN NP (OWNER)
(937) 544-4020
Entity
Organization
Contact information
Practice address
225 CLEVELAND AVE, MILFORD, OH 45150-1099
(513) 248-1270
Mailing address
7854 SPLIT RAIL CT, MASON, OH 45040-7982
(513) 204-2854
(937) 544-4009
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1053364737
NPI INDIVIDUAL
OH
05
—
2693778
—
OH
Enumeration date
05/07/2018
Last updated
05/07/2018
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