Provider Demographics
NPI:1871807305
Name:HANSEN, HEATHER LYNN (LPN)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LYNN
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:LYNN
Other - Last Name:FLINT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:637 DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310-4029
Mailing Address - Country:US
Mailing Address - Phone:330-608-8128
Mailing Address - Fax:
Practice Address - Street 1:637 DAVIS ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-4029
Practice Address - Country:US
Practice Address - Phone:330-608-8128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.138746-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse