Provider Demographics
NPI:1306817416
Name:HEINITZ, HELEN M (ARNP)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:M
Last Name:HEINITZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 1A
Mailing Address - Street 2:
Mailing Address - City:LAKIN
Mailing Address - State:KS
Mailing Address - Zip Code:67860-9708
Mailing Address - Country:US
Mailing Address - Phone:620-355-7550
Mailing Address - Fax:
Practice Address - Street 1:506 THORPE ST
Practice Address - Street 2:
Practice Address - City:LAKIN
Practice Address - State:KS
Practice Address - Zip Code:67860
Practice Address - Country:US
Practice Address - Phone:620-355-7550
Practice Address - Fax:620-355-7500
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44661363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSS45758Medicare UPIN
KS48899Medicare ID - Type Unspecified