Provider Demographics
NPI:1154795870
Name:WINDER, HEIDI (FNP-C)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:WINDER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 E CHUBBUCK RD
Mailing Address - Street 2:
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-1816
Mailing Address - Country:US
Mailing Address - Phone:208-233-9898
Mailing Address - Fax:208-232-8566
Practice Address - Street 1:476 E CHUBBUCK RD
Practice Address - Street 2:
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-1816
Practice Address - Country:US
Practice Address - Phone:208-233-9898
Practice Address - Fax:208-232-8566
Is Sole Proprietor?:No
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1654A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily