Healthcare Provider Details

I. General information

NPI: 1386267334
Provider Name (Legal Business Name): MELISSA WANDA MA-HEIMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA WANDA MA-HEIMAN RN

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3211 S SENECA ST
WICHITA KS
67217-3348
US

IV. Provider business mailing address

PO BOX 932958
CLEVELAND OH
44193-0028
US

V. Phone/Fax

Practice location:
  • Phone: 316-670-1582
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number79437
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number219617
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-79437-032
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number13-98393-032
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: