Provider Demographics
NPI:1487886842
Name:HEEN, DENA GEETA (LRD)
Entity type:Individual
Prefix:MRS
First Name:DENA
Middle Name:GEETA
Last Name:HEEN
Suffix:
Gender:F
Credentials:LRD
Other - Prefix:MS
Other - First Name:DENA
Other - Middle Name:GEETA
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LRD
Mailing Address - Street 1:1514 PEBBLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-4521
Mailing Address - Country:US
Mailing Address - Phone:320-293-5240
Mailing Address - Fax:
Practice Address - Street 1:1514 PEBBLE CREEK DR
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4521
Practice Address - Country:US
Practice Address - Phone:320-293-5240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-19
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN881120133V00000X
MN2191133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered