Healthcare Provider Details

I. General information

NPI: 1952308397
Provider Name (Legal Business Name): COURTNEY-MAREE HEYNEN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 10/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 S. CLIFF AVE. STE. 401
SIOUX FALLS SD
57105-1064
US

IV. Provider business mailing address

PO BOX 86370
SIOUX FALLS SD
57118-6370
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-8920
  • Fax: 605-322-8919
Mailing address:
  • Phone: 605-322-7510
  • Fax: 605-322-8919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN160603
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCM000065
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: