Provider Demographics
NPI:1033792197
Name:HEINLEIN, MEREDITH ANNE (DNP)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:ANNE
Last Name:HEINLEIN
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:ANNE
Other - Last Name:STOKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP
Mailing Address - Street 1:PO BOX 776982
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6982
Mailing Address - Country:US
Mailing Address - Phone:231-672-2119
Mailing Address - Fax:313-432-7759
Practice Address - Street 1:1150 E SHERMAN BLVD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1871
Practice Address - Country:US
Practice Address - Phone:231-672-6740
Practice Address - Fax:231-672-6787
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704316205363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology