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NPI Code Detail

MEDICARE: BERNICE HEINRICH RN

MEDICARE:   BERNICE  HEINRICH  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
1163WS0200XSchool Registered NurseRN114253AZ

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 : 1821295189
Entity Type Code : Individual
Provider Name (Legal Business Name) : BERNICE HEINRICH RN
Provider Business Mailing Address
First Line : 2200 HAVASUPAI BLVD
Second Line :
City : LAKE HAVASU CITY
State : AZ
Zip : 86403-3122
Country : US
Telephone Number : 928-505-6911
Fax Number : 928-505-6991
Provider Business Practice Location Address
First Line : 2200 HAVASUPAI BLVD
Second Line :
City : LAKE HAVASU CITY
State : AZ
Zip : 86403-3122
Country : US
Telephone Number : 928-505-6911
Fax Number : 928-505-6991
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2007
Last Update Date : 07/09/2007

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