Provider Demographics
NPI:1588066492
Name:HONOR FAMILY PRACTICE PLLC
Entity type:Organization
Organization Name:HONOR FAMILY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:231-325-2277
Mailing Address - Street 1:10524 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HONOR
Mailing Address - State:MI
Mailing Address - Zip Code:49640-9461
Mailing Address - Country:US
Mailing Address - Phone:231-325-2277
Mailing Address - Fax:231-325-2279
Practice Address - Street 1:10524 MAIN ST
Practice Address - Street 2:
Practice Address - City:HONOR
Practice Address - State:MI
Practice Address - Zip Code:49640-9461
Practice Address - Country:US
Practice Address - Phone:231-325-2277
Practice Address - Fax:231-325-2279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI233967261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0A01019OtherBLUE CROSS AND BLUE SHIELD