Provider Demographics
NPI:1164747895
Name:HEINEY, CARRIE LEE (MSN, CRNA)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:LEE
Last Name:HEINEY
Suffix:
Gender:F
Credentials:MSN, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PEMBERTON DR
Mailing Address - Street 2:
Mailing Address - City:EAST BERLIN
Mailing Address - State:PA
Mailing Address - Zip Code:17316-9318
Mailing Address - Country:US
Mailing Address - Phone:717-476-1373
Mailing Address - Fax:
Practice Address - Street 1:30 PEMBERTON DR
Practice Address - Street 2:
Practice Address - City:EAST BERLIN
Practice Address - State:PA
Practice Address - Zip Code:17316-9318
Practice Address - Country:US
Practice Address - Phone:717-476-1373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2024-02-08
Deactivation Date:2012-08-14
Deactivation Code:
Reactivation Date:2013-01-11
Provider Licenses
StateLicense IDTaxonomies
PARN584506163W00000X
WY45294367500000X
PA92104367500000X
NH079507-23367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse