Provider Demographics
NPI:1114148129
Name:HEITHOFF, JANE L (RN, CPNP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:L
Last Name:HEITHOFF
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23751 HIGHWAY 30
Mailing Address - Street 2:PO BOX 427
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-0427
Mailing Address - Country:US
Mailing Address - Phone:712-792-9266
Mailing Address - Fax:
Practice Address - Street 1:23751 HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-0427
Practice Address - Country:US
Practice Address - Phone:712-792-9266
Practice Address - Fax:712-792-5723
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC-056332363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA52501OtherWELLMARK BLUE CROSS BLUE