Provider Demographics
NPI:1386122505
Name:HEINECKE, ELIZABETH TERESIA (RN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:TERESIA
Last Name:HEINECKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7634 ASHTON DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-3920
Mailing Address - Country:US
Mailing Address - Phone:833-760-9796
Mailing Address - Fax:
Practice Address - Street 1:7634 ASHTON DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-3920
Practice Address - Country:US
Practice Address - Phone:833-760-9796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX679321163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679321OtherBOARD OF NURSING