Healthcare Provider Details

I. General information

NPI: 1780592022
Provider Name (Legal Business Name): ANDREW HEETER CSFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 NORTHLAND DR
PRINCETON MN
55371-2172
US

IV. Provider business mailing address

24530 140TH ST NW
ZIMMERMAN MN
55398-5402
US

V. Phone/Fax

Practice location:
  • Phone: 612-672-5000
  • Fax:
Mailing address:
  • Phone: 612-672-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number182961
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: