Provider Demographics
NPI:1588948699
Name:HEINEMAN, JENNIFER A (RN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:A
Last Name:HEINEMAN
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 1:29 TOWNSEND AVE
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-1321
Mailing Address - Country:US
Mailing Address - Phone:307-329-3994
Mailing Address - Fax:
Practice Address - Street 1:143 PRINCETON AVE
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-1716
Practice Address - Country:US
Practice Address - Phone:607-936-3791
Practice Address - Fax:607-654-2798
Is Sole Proprietor?:No
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY564338163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool