Provider Demographics
NPI:1588339717
Name:WYCKOFF, HEATHER DAWN (CNA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:DAWN
Last Name:WYCKOFF
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 1:116 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:MANNINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26582-3043
Mailing Address - Country:US
Mailing Address - Phone:304-825-6246
Mailing Address - Fax:
Practice Address - Street 1:116 VALLEY DR
Practice Address - Street 2:
Practice Address - City:MANNINGTON
Practice Address - State:WV
Practice Address - Zip Code:26582-3043
Practice Address - Country:US
Practice Address - Phone:304-825-6364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide