Provider Demographics
NPI:1205820552
Name:HEINOLD, ANNE LOUISE (APN FNP)
Entity Type:Individual
Prefix:MISS
First Name:ANNE
Middle Name:LOUISE
Last Name:HEINOLD
Suffix:
Gender:F
Credentials:APN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:1701 S CREASY LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4972
Practice Address - Country:US
Practice Address - Phone:765-502-4917
Practice Address - Fax:765-502-4023
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004835363L00000X
IN28221087A363L00000X
IN71005430A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN153475200Medicaid
INM47140187OtherMEDICARE
IN201331250Medicaid
ILK15645Medicare UPIN