Individual
GINA HEBERLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
508 W PINE ST, FARMINGTON, MO 63640-1426
(573) 747-1510
(573) 747-1512
Mailing address
508 W PINE ST, FARMINGTON, MO 63640-1426
(573) 747-1510
(573) 747-1512
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
139404
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
429193402
—
MO
Enumeration date
08/23/2006
Last updated
03/11/2010
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