Healthcare Provider Details

I. General information

NPI: 1700257169
Provider Name (Legal Business Name): ERIN HEINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2015
Last Update Date: 12/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E CLAFLIN AVE
SALINA KS
67401-6146
US

IV. Provider business mailing address

617 APPLEWOOD DR
YANKTON SD
57078-5138
US

V. Phone/Fax

Practice location:
  • Phone: 605-661-7453
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2602
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number529-14
License Number StateND
# 3
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number24-01117
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: