=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730105628
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NANCY HEINK CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 234 GOODMAN ST
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45219-2364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-584-3683
-----------------------------------------------------
Fax | 513-584-7217
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3200 BURNET AVE 1 RIDGEWAY
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45229-3019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-585-9009
-----------------------------------------------------
Fax | 513-585-9373
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | NS02150 NP07575
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------