Healthcare Provider Details

I. General information

NPI: 1184255614
Provider Name (Legal Business Name): ANNETTE HEIL APRN.CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 11/03/2023
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E 2ND ST
DEFIANCE OH
43512
US

IV. Provider business mailing address

1200 RALSTON AVE
DEFIANCE OH
43512-1396
US

V. Phone/Fax

Practice location:
  • Phone: 419-783-6955
  • Fax:
Mailing address:
  • Phone: 419-783-6955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.026155
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: