Provider Demographics
NPI:1467275982
Name:BROWN, HEIDI (LMT, RN, CFNC, CNP)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMT, RN, CFNC, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15
Mailing Address - Street 2:
Mailing Address - City:WAKARUSA
Mailing Address - State:IN
Mailing Address - Zip Code:46573-0015
Mailing Address - Country:US
Mailing Address - Phone:574-202-4743
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 15
Practice Address - Street 2:
Practice Address - City:WAKARUSA
Practice Address - State:IN
Practice Address - Zip Code:46573-0015
Practice Address - Country:US
Practice Address - Phone:574-202-4743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education