Healthcare Provider Details

I. General information

NPI: 1215996244
Provider Name (Legal Business Name): CHRISTIE ANN VAN HECKE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 7TH ST NW
CASS LAKE MN
56633-3360
US

IV. Provider business mailing address

425 7TH ST NW
CASS LAKE MN
56633-3360
US

V. Phone/Fax

Practice location:
  • Phone: 218-335-3200
  • Fax: 218-335-3327
Mailing address:
  • Phone: 218-335-3200
  • Fax: 218-335-3327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1272581
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1272581
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2582
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: