MEDICARE: MS. LORETTA J HEINEN PAC

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
1	363A00000X	Physician Assistant	15-01231	KS

General Provider Information

NPI Number	:	1588858526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LORETTA J HEINEN PAC

Provider Business Mailing Address
First Line	:	9800 TROUP AVENUE
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66111-1870
Country	:	US
Telephone Number	:	913-297-7472
Fax Number	:	913-788-5878

Provider Business Practice Location Address
First Line	:	9800 TROUP AVENUE
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66111-1870
Country	:	US
Telephone Number	:	913-297-7472
Fax Number	:	913-788-5878

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2007
Last Update Date	:	06/01/2021

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