Provider Demographics
NPI: | 1134312747 |
---|---|
Name: | JAYNES, HEATHER M (CNNP) |
Entity Type: | Individual |
Prefix: | |
First Name: | HEATHER |
Middle Name: | M |
Last Name: | JAYNES |
Suffix: | |
Gender: | F |
Credentials: | CNNP |
Other - Prefix: | |
Other - First Name: | HEATHER |
Other - Middle Name: | A |
Other - Last Name: | MANEY |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | |
Mailing Address - Street 1: | 2910 CENTRE POINTE DR |
Mailing Address - Street 2: | MAIL STOP 35-121A |
Mailing Address - City: | ROSEVILLE |
Mailing Address - State: | MN |
Mailing Address - Zip Code: | 55113-1182 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 651-855-2327 |
Mailing Address - Fax: | 651-855-2310 |
Practice Address - Street 1: | 347 NORTH SMITH AVENUE |
Practice Address - Street 2: | CHILDRENS SPECIALTY CLINIC NICU |
Practice Address - City: | ST. PAUL |
Practice Address - State: | MN |
Practice Address - Zip Code: | 55102 |
Practice Address - Country: | US |
Practice Address - Phone: | 651-220-6210 |
Practice Address - Fax: | 651-220-7777 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-08-27 |
Last Update Date: | 2012-11-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MN | R1533356 | 363LN0000X, 363LN0005X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LN0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal |
No | 363LN0005X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal, Critical Care |