Provider Demographics
NPI:1386364370
Name:HEFNER, CHRISTINE GRACE
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:GRACE
Last Name:HEFNER
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:PO BOX 376
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-0376
Mailing Address - Country:US
Mailing Address - Phone:740-648-9042
Mailing Address - Fax:
Practice Address - Street 1:655 EBB TOMBLIN RD LOT 4
Practice Address - Street 2:
Practice Address - City:THURMAN
Practice Address - State:OH
Practice Address - Zip Code:45685-9763
Practice Address - Country:US
Practice Address - Phone:740-648-9042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant