Healthcare Provider Details

I. General information

NPI: 1508195074
Provider Name (Legal Business Name): JUSTINE MARIE HEIN RN,BSN,CWOCN,CFCN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2009
Last Update Date: 12/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PARK BLVD
BRISTOL TN
37620-7430
US

IV. Provider business mailing address

462 MILL CREEK RD
KINGSPORT TN
37664-5802
US

V. Phone/Fax

Practice location:
  • Phone: 423-844-4405
  • Fax:
Mailing address:
  • Phone: 423-863-3805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberRN0000054163
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: