Provider Demographics
NPI:1861211278
Name:HELLER, KATHLEEN
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:HELLER
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 1:1652 LAZZELLE UNION RD
Mailing Address - Street 2:
Mailing Address - City:MAIDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26541-8153
Mailing Address - Country:US
Mailing Address - Phone:304-328-5168
Mailing Address - Fax:
Practice Address - Street 1:1652 LAZZELLE UNION RD
Practice Address - Street 2:
Practice Address - City:MAIDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26541-8153
Practice Address - Country:US
Practice Address - Phone:304-328-5168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide