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NPI Code Detail

MEDICARE: MR. TERRENCE JOHN HEIDENREITER RNC

MEDICARE: MR. TERRENCE JOHN HEIDENREITER RNC
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
1363LW0102XWomen's Health Nurse PractitionerR152573MD

General Provider Information

NPI Number : 1346230125
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TERRENCE JOHN HEIDENREITER RNC
Provider Business Mailing Address
First Line : 2480 LLEWELLYN AVE
Second Line : ATTN: MCXR-CR KIMBROUGH AMBULATORY CARE CENTER
City : FT MEADE
State : MD
Zip : 20755-5800
Country : US
Telephone Number : 301-677-8270
Fax Number : 301-677-8176
Provider Business Practice Location Address
First Line : 2480 LLEWELLYN AVE
Second Line : RED TEAM
City : FT MEADE
State : MD
Zip : 20755-5800
Country : US
Telephone Number : 301-677-8949
Fax Number : 301-677-8499
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2005
Last Update Date : 07/08/2007

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