Provider Demographics
NPI:1144837824
Name:GRIBBLE, HEATHER
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:GRIBBLE
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 1:7346 CHERRY RUN RD NW
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:OH
Mailing Address - Zip Code:44624-9302
Mailing Address - Country:US
Mailing Address - Phone:330-204-1974
Mailing Address - Fax:
Practice Address - Street 1:7346 CHERRY RUN RD NW # 7
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:OH
Practice Address - Zip Code:44624-9302
Practice Address - Country:US
Practice Address - Phone:330-204-1974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7901300OtherDODD