Healthcare Provider Details

I. General information

NPI: 1730162330
Provider Name (Legal Business Name): ANNE PATRICIA HEINLY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MISSLE AVE
MINOT AFB ND
58705-5003
US

IV. Provider business mailing address

133 CORAL CT
MINOT AFB ND
58704-1319
US

V. Phone/Fax

Practice location:
  • Phone: 701-723-5114
  • Fax:
Mailing address:
  • Phone: 701-727-0462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: