MEDICARE: JONATHAN ANDREW HEISINGER

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	174H00000X	Health Educator

General Provider Information

NPI Number	:	1932429727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN ANDREW HEISINGER

Provider Business Mailing Address
First Line	:	3834 OXFORD RD
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-5341
Country	:	US
Telephone Number	:	573-462-6966
Fax Number	:	573-635-0815

Provider Business Practice Location Address
First Line	:	1505 SOUTHWEST BLVD
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65102-1128
Country	:	US
Telephone Number	:	573-462-6966
Fax Number	:	573-635-0815

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

Provider Enumeration Date	:	06/03/2010
Last Update Date	:	06/28/2010

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