Provider Demographics
NPI:1891232526
Name:HEATHMAN, MAUREEN PATRICIA
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:PATRICIA
Last Name:HEATHMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 E SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-1668
Mailing Address - Country:US
Mailing Address - Phone:248-676-9465
Mailing Address - Fax:
Practice Address - Street 1:470 E SUMMIT ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1668
Practice Address - Country:US
Practice Address - Phone:248-676-9465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704224374163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator