Provider Demographics
NPI:1912307430
Name:GIFFIN, HEIDI MARIE (LICENSED PRACTICAL N)
Entity type:Individual
Prefix:MISS
First Name:HEIDI
Middle Name:MARIE
Last Name:GIFFIN
Suffix:
Gender:F
Credentials:LICENSED PRACTICAL N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 WALL ST
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:NY
Mailing Address - Zip Code:13074-2120
Mailing Address - Country:US
Mailing Address - Phone:315-564-5208
Mailing Address - Fax:
Practice Address - Street 1:221 WALL ST
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:NY
Practice Address - Zip Code:13074-2120
Practice Address - Country:US
Practice Address - Phone:315-564-5208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305099164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse