Healthcare Provider Details

I. General information

NPI: 1528061942
Provider Name (Legal Business Name): DENNIS WILLIAM HEIBEIN CRNA, MSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 02/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 COUNTY RD
WINDSOR VT
05089-9000
US

IV. Provider business mailing address

289 COUNTY RD
WINDSOR VT
05089-9000
US

V. Phone/Fax

Practice location:
  • Phone: 802-674-7300
  • Fax: 802-674-7314
Mailing address:
  • Phone: 802-674-7300
  • Fax: 802-674-7314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number043575-23-11
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1010091185
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: