Provider Demographics
NPI:1770759433
Name:HERON, RICHARD P (LPN)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:P
Last Name:HERON
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 E SECOND ST
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3032
Mailing Address - Country:US
Mailing Address - Phone:610-565-3658
Mailing Address - Fax:610-259-9835
Practice Address - Street 1:228 E SECOND ST
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3032
Practice Address - Country:US
Practice Address - Phone:610-565-3658
Practice Address - Fax:610-259-9835
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN064949L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse