Healthcare Provider Details

I. General information

NPI: 1982849063
Provider Name (Legal Business Name): JULIE IRENE HEITMANN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE IRENE SCHUSTER R.N.

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 12/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LAKE TRAVERSE DR
SISSETON SD
57262-7046
US

IV. Provider business mailing address

100 LAKE TRAVERSE DR
SISSETON SD
57262-7046
US

V. Phone/Fax

Practice location:
  • Phone: 605-698-7606
  • Fax: 605-742-0182
Mailing address:
  • Phone: 605-698-7606
  • Fax: 605-742-0182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberSD-RN R015614
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: