Provider Demographics
NPI:1093456733
Name:SANDNAS, HEATHER RAE (RN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:RAE
Last Name:SANDNAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:RAE
Other - Last Name:JORGENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2330 5TH AVE W
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-1530
Mailing Address - Country:US
Mailing Address - Phone:320-223-9566
Mailing Address - Fax:
Practice Address - Street 1:2330 5TH AVE W
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-1530
Practice Address - Country:US
Practice Address - Phone:320-223-9566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR227353-4163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse