Gregory Heaven, LPN
Individual provider Active NPI Licensed Practical Nurse · Leetonia, OH
NPI 1396017463 · NPPES record last updated Feb 3, 2012
Key facts
- NPI
- 1396017463
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- PN138531MIV (OH)
- Practice address
- 100 Wilson St
Leetonia, OH 44431-9601 - Phone
- (330) 717-5502
- NPI assigned
- Feb 3, 2012
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PN138531MIV | OH | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | PN138531MIV | OH | Yes |
Addresses
Primary practice location
100 Wilson St
Leetonia, OH 44431-9601
Mailing address
100 Wilson St
Leetonia, OH 44431-9601
Phone (330) 717-5502
Other providers in Leetonia, OH
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All providers in Leetonia, OH · Licensed Practical Nurse in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 3, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.