Individual
HEATHER BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
115 PRIVATE ROAD 977, PEDRO, OH 45659-8608
(740) 534-1386
(740) 534-1497
Mailing address
115 PRIVATE ROAD 977, PEDRO, OH 45659-8608
(740) 534-1386
(740) 534-1497
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
173189
OH
Other
Enumeration date
12/18/2019
Last updated
12/18/2019
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