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General NPI Number Information
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NPI Number | 1730624990
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Entity Type | Individual
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Provider Name | REBECCA HEISINGER CRNA
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Gender | Female
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Dates
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Enumeration Date | 12/27/2016
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Last Update Date | 02/10/2021
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Provider Practice Location Address
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Address Line | 625 E BROADWAY AVE
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City | JACKSON
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State | WY
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Zip | 83001-8642
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Country | US
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Telephone | 307-739-7218
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Fax | 307-739-7446
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Provider Business Mailing Address
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Address Line | PO BOX 428
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City | JACKSON
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State | WY
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Zip | 83001-0428
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Country | US
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Telephone | 307-739-7218
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Fax | 307-739-7446
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 39663.1621
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License Number State | WY
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