Provider Demographics
NPI:1093084774
Name:HEIKENFELD, JALEAN LOUISE (APRN)
Entity Type:Individual
Prefix:
First Name:JALEAN
Middle Name:LOUISE
Last Name:HEIKENFELD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JALEAN
Other - Middle Name:LOUISE
Other - Last Name:STUDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-655-8910
Mailing Address - Fax:859-655-8911
Practice Address - Street 1:1640 FLOSSIE DRIVE
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:IN
Practice Address - Zip Code:47025
Practice Address - Country:US
Practice Address - Phone:859-655-8910
Practice Address - Fax:859-655-8911
Is Sole Proprietor?:No
Enumeration Date:2011-12-23
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN. 321130163W00000X
OH16224363L00000X
KY3008919363L00000X
IN71005409A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100321870Medicaid
KYK171390Medicare PIN