Provider Demographics
NPI:1104535087
Name:HEISNER, PAUL
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:HEISNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:CUMMINGS
Mailing Address - State:ND
Mailing Address - Zip Code:58223-2301
Mailing Address - Country:US
Mailing Address - Phone:701-636-2028
Mailing Address - Fax:
Practice Address - Street 1:24 FRONT ST
Practice Address - Street 2:
Practice Address - City:CUMMINGS
Practice Address - State:ND
Practice Address - Zip Code:58223-2301
Practice Address - Country:US
Practice Address - Phone:701-636-2028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant