Provider Demographics
NPI:1104707629
Name:HEARON, MARY (CNA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:HEARON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:CALDWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNA
Mailing Address - Street 1:137 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:SC
Mailing Address - Zip Code:29069-9264
Mailing Address - Country:US
Mailing Address - Phone:843-467-6030
Mailing Address - Fax:
Practice Address - Street 1:137 RIVER RD
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:SC
Practice Address - Zip Code:29069-9264
Practice Address - Country:US
Practice Address - Phone:843-467-6030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9983451251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care