Provider Demographics
NPI:1326297771
Name:PROFESSIONAL RESOURCE NETWORK
Entity Type:Organization
Organization Name:PROFESSIONAL RESOURCE NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:EVA
Authorized Official - Last Name:HEUHS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-482-0885
Mailing Address - Street 1:2002 E SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3143
Mailing Address - Country:US
Mailing Address - Phone:517-482-0885
Mailing Address - Fax:
Practice Address - Street 1:2002 E SAGINAW ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3143
Practice Address - Country:US
Practice Address - Phone:517-482-0885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty