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NPI Code Detail

MEDICARE: KIRSTEN MELISSA JACOBSEN HEARNE R.N.

MEDICARE: KIRSTEN MELISSA JACOBSEN HEARNE R.N.
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
1163WS0200XSchool Registered NurseRN107122AZ

General Provider Information

NPI Number : 1144342643
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIRSTEN MELISSA JACOBSEN HEARNE R.N.
Provider Business Mailing Address
First Line : PO BOX 30421
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86003-0421
Country : US
Telephone Number : 928-774-9365
Fax Number :
Provider Business Practice Location Address
First Line : 3285 E SPARROW AVE
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86004-7794
Country : US
Telephone Number : 928-773-4122
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2007
Last Update Date : 07/08/2007

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