Provider Demographics
NPI:1215643036
Name:MACE, HEATHER
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MACE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 HARMONY RD
Mailing Address - Street 2:
Mailing Address - City:GANDEEVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25243-8709
Mailing Address - Country:US
Mailing Address - Phone:304-577-9062
Mailing Address - Fax:
Practice Address - Street 1:1222 MARKET ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-4323
Practice Address - Country:US
Practice Address - Phone:304-865-5420
Practice Address - Fax:304-471-2488
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker