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NPI Code Detail

MEDICARE: LYNN M HEISE ACNP

MEDICARE: LYNN M HEISE ACNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner1993-033WI
2363L00000XNurse PractitionerAP125622TX
3363LA2100XAcute Care Nurse PractitionerAP125622TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093791022
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYNN M HEISE ACNP
Provider Business Mailing Address
First Line : PO BOX 844658
Second Line :
City : DALLAS
State : TX
Zip : 75284-4658
Country : US
Telephone Number : 254-724-2111
Fax Number :
Provider Business Practice Location Address
First Line : 2601 THORNTON LN
Second Line :
City : TEMPLE
State : TX
Zip : 76502-1808
Country : US
Telephone Number : 254-724-6622
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2005
Last Update Date : 11/11/2016

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