Individual
NICOLE MARIE HEAVNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
900 20TH ST, HUNTINGTON, WV 25703-1810
(681) 378-3908
Mailing address
402 6TH AVE, HUNTINGTON, WV 25701-1950
(681) 362-3747
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
175T00000X
—
WV
Enumeration date
04/26/2022
Last updated
04/26/2022
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