MEDICARE: MS. MAUREEN CAROL HEINZ CNM

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	163WP1700X	Perinatal Registered Nurse	4704180167	MI
2	367A00000X	Advanced Practice Midwife	4704180167	MI

General Provider Information

NPI Number	:	1801170345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MAUREEN CAROL HEINZ CNM

Provider Business Mailing Address
First Line	:	69618 N MAIN ST
Second Line	:
City	:	RICHMOND
State	:	MI
Zip	:	48062-1009
Country	:	US
Telephone Number	:	586-727-1271
Fax Number	:

Provider Business Practice Location Address
First Line	:	69618 N MAIN ST
Second Line	:
City	:	RICHMOND
State	:	MI
Zip	:	48062-1009
Country	:	US
Telephone Number	:	586-727-1271
Fax Number	:

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

Provider Enumeration Date	:	10/03/2011
Last Update Date	:	01/19/2016

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