Provider Demographics
NPI:1235200452
Name:TORRENCE-HEINZ, JUNE RENEE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JUNE
Middle Name:RENEE
Last Name:TORRENCE-HEINZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:JUNE
Other - Middle Name:RENEE
Other - Last Name:TORRENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 5TH AVE
Practice Address - Street 2:
Practice Address - City:IPSWICH
Practice Address - State:SD
Practice Address - Zip Code:57451-2038
Practice Address - Country:US
Practice Address - Phone:605-426-6040
Practice Address - Fax:605-426-6043
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0298363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5300910Medicaid
SDR02598Medicare UPIN
SD5300910Medicaid