Provider Demographics
NPI:1134146624
Name:VANDERHEIDE, BARBARA L (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:L
Last Name:VANDERHEIDE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 W MIDLAND RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MI
Mailing Address - Zip Code:48611-9420
Mailing Address - Country:US
Mailing Address - Phone:989-662-2740
Mailing Address - Fax:989-662-2745
Practice Address - Street 1:939 W MIDLAND RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MI
Practice Address - Zip Code:48611-9420
Practice Address - Country:US
Practice Address - Phone:989-662-2740
Practice Address - Fax:989-662-2745
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704116244363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
M95020004Medicare ID - Type Unspecified
P32946Medicare UPIN