Provider Demographics
NPI:1093798761
Name:HEINBAUGH, NAN SHIRLEY
Entity Type:Individual
Prefix:
First Name:NAN
Middle Name:SHIRLEY
Last Name:HEINBAUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 W KIME ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-3854
Mailing Address - Country:US
Mailing Address - Phone:336-228-8530
Mailing Address - Fax:
Practice Address - Street 1:108 W KIME ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-3854
Practice Address - Country:US
Practice Address - Phone:336-228-8530
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0519103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical