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NPI Code Detail

MEDICARE: HEIDI GENEREUX C.R.N.A.

MEDICARE: HEIDI GENEREUX C.R.N.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse AnesthetistR 095825 9MN
2367500000XCertified Registered Nurse AnesthetistR20219ND

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1430051818OTHERMNPALMETTO GBA - RAILROAD MEDICARE
4430051818OTHERNDPALMETTA GBA - RAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1124135629
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEIDI GENEREUX C.R.N.A.
Provider Business Mailing Address
First Line : PO BOX 1296
Second Line :
City : WARSAW
State : IN
Zip : 46581-1296
Country : US
Telephone Number : 574-268-9640
Fax Number : 574-268-0684
Provider Business Practice Location Address
First Line : 2400 ST FRANCIS DR
Second Line :
City : BRECKENRIDGE
State : MN
Zip : 56520-1025
Country : US
Telephone Number : 218-643-3000
Fax Number : 574-268-0684
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2006
Last Update Date : 08/14/2013

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Directions to “ HEIDI GENEREUX C.R.N.A.” Practice Location

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