Provider Demographics
NPI:1194012302
Name:PUSEY, HEIDI RENEE (CNP)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:RENEE
Last Name:PUSEY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:R
Other - Last Name:BALDWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 67000
Mailing Address - Street 2:DEPARTMENT 272801
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-2728
Mailing Address - Country:US
Mailing Address - Phone:517-782-2555
Mailing Address - Fax:517-782-3399
Practice Address - Street 1:1401 W NORTH ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-3135
Practice Address - Country:US
Practice Address - Phone:517-782-2555
Practice Address - Fax:517-782-3399
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704221349363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner