Provider Demographics
NPI:1871895649
Name:WASHBURN, HEATHER LYNN (CNA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:WASHBURN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:473 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IN
Mailing Address - Zip Code:46970-2833
Mailing Address - Country:US
Mailing Address - Phone:765-460-5278
Mailing Address - Fax:
Practice Address - Street 1:473 S BROADWAY
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-2833
Practice Address - Country:US
Practice Address - Phone:765-460-5278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INCNA1002735376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide