Provider Demographics
NPI:1376202598
Name:LOEBIG, HEIDI J (RN)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:J
Last Name:LOEBIG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:JO
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:9 2ND AVE NW
Mailing Address - Street 2:
Mailing Address - City:WAUKON
Mailing Address - State:IA
Mailing Address - Zip Code:52172-1603
Mailing Address - Country:US
Mailing Address - Phone:563-568-1274
Mailing Address - Fax:
Practice Address - Street 1:702 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-2317
Practice Address - Country:US
Practice Address - Phone:563-382-8765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA126853163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse