MEDICARE: MARGARET HEATON RN

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	163W00000X	Registered Nurse	R164540-6	MN

General Provider Information

NPI Number	:	1952756579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARET HEATON RN

Provider Business Mailing Address
First Line	:	7511 170TH AVE NE
Second Line	:
City	:	FOREST LAKE
State	:	MN
Zip	:	55025-8806
Country	:	US
Telephone Number	:	651-245-8805
Fax Number	:

Provider Business Practice Location Address
First Line	:	7511 170TH AVE NE
Second Line	:
City	:	FOREST LAKE
State	:	MN
Zip	:	55025-8806
Country	:	US
Telephone Number	:	651-245-8805
Fax Number	:

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

Provider Enumeration Date	:	05/02/2016
Last Update Date	:	05/02/2016

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