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NPI Code Detail

MEDICARE: AMY HEISS RN

MEDICARE: AMY HEISS RN
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
1163WC0200XCritical Care Medicine Registered Nurse475857CA

General Provider Information

NPI Number : 1174119564
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY HEISS RN
Provider Business Mailing Address
First Line : 4778 KANSAS ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92116-1513
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5500 CAMPANILE DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92182-0003
Country : US
Telephone Number : 619-594-6384
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2020
Last Update Date : 12/19/2020

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