Individual
SHANNON RAE HEFFERN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
1200 N. BEAVER, FLAGSTAFF, AZ 86001
(928) 214-2800
(928) 773-2421
Mailing address
1200 N. BEAVER, PAYER CREDENTIALING, FLAGSTAFF, AZ 86001
(928) 213-6235
(928) 213-6292
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
706932
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
233789
—
AZ
Enumeration date
06/12/2012
Last updated
03/16/2017
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