Provider Demographics
NPI:1194061697
Name:HEINRICH, CARA (RT(R)(M))
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:HEINRICH
Suffix:
Gender:F
Credentials:RT(R)(M)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 LYNNFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-7005
Mailing Address - Country:US
Mailing Address - Phone:757-606-2444
Mailing Address - Fax:
Practice Address - Street 1:5589 GREENWICH RD
Practice Address - Street 2:#175
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6565
Practice Address - Country:US
Practice Address - Phone:757-434-3970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2013-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0120006199247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other