Provider Demographics
NPI:1598595431
Name:HEINIMANN, CHRISTINE ANN (LPN)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANN
Last Name:HEINIMANN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 HOME ST
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565-1848
Mailing Address - Country:US
Mailing Address - Phone:516-444-6094
Mailing Address - Fax:
Practice Address - Street 1:430 IRVING AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2343
Practice Address - Country:US
Practice Address - Phone:315-426-7640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY321234164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse