Provider Demographics
NPI:1144742982
Name:JUST, HEIDI EBNER (RN 00114867)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:EBNER
Last Name:JUST
Suffix:
Gender:F
Credentials:RN 00114867
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:STEILACOOM
Mailing Address - State:WA
Mailing Address - Zip Code:98388-3702
Mailing Address - Country:US
Mailing Address - Phone:253-820-9733
Mailing Address - Fax:
Practice Address - Street 1:14016 A ST S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-4662
Practice Address - Country:US
Practice Address - Phone:253-503-3649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00114867163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse