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General NPI Number Information
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NPI Number | 1386016186
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Entity Type | Individual
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Provider Name | KATIE MARIE HEISING FNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/20/2015
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Last Update Date | 10/20/2015
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Provider Practice Location Address
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Address Line | 11100 EUCLID AVE
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City | CLEVELAND
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State | OH
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Zip | 44106-1716
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Country | US
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Telephone | 216-286-6763
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Fax |
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Provider Business Mailing Address
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Address Line | 304 E 293RD ST
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City | WILLOWICK
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State | OH
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Zip | 44095-4651
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Country | US
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Telephone | 440-821-7647
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | COA-17977-NP
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License Number State | OH
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