MEDICARE: MICHELLE ANN HEISTAND

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
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1639971716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE ANN HEISTAND

Provider Business Mailing Address
First Line	:	4204 COUNTRY CLUB RD SW
Second Line	:
City	:	LANCASTER
State	:	OH
Zip	:	43130-8936
Country	:	US
Telephone Number	:	740-438-6163
Fax Number	:

Provider Business Practice Location Address
First Line	:	4204 COUNTRY CLUB RD SW
Second Line	:
City	:	LANCASTER
State	:	OH
Zip	:	43130-8936
Country	:	US
Telephone Number	:	740-438-6163
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2025
Last Update Date	:	03/27/2025

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Directions to “ MICHELLE ANN HEISTAND ” Practice Location

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