Provider Demographics
NPI:1285934158
Name:JEWELL, HEATHER NICHOLE
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:NICHOLE
Last Name:JEWELL
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 1:500 TILE PLANT RD SE
Mailing Address - Street 2:LOT 8
Mailing Address - City:NEW LEXINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43764-9700
Mailing Address - Country:US
Mailing Address - Phone:740-605-2985
Mailing Address - Fax:
Practice Address - Street 1:500 TILE PLANT RD SE
Practice Address - Street 2:LOT 8
Practice Address - City:NEW LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:43764-9700
Practice Address - Country:US
Practice Address - Phone:740-605-2985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN127141164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse