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Individual

GREGORY HEAVEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LPN

Contact information

Practice address
100 WILSON ST, LEETONIA, OH 44431-9601
(330) 717-5502
Mailing address
100 WILSON ST, LEETONIA, OH 44431-9601
(330) 717-5502

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN138531MIV
OH

Other

Enumeration date
02/03/2012
Last updated
02/03/2012
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