Provider Demographics
NPI:1386864445
Name:IRWIN, HEIDI H (MSN)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:H
Last Name:IRWIN
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:JEANNE
Other - Last Name:HUNTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10602 HUNTERS GLEN DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-4849
Mailing Address - Country:US
Mailing Address - Phone:858-755-7484
Mailing Address - Fax:858-755-7484
Practice Address - Street 1:9415 CAMPUS POINT DRIVE
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093
Practice Address - Country:US
Practice Address - Phone:858-822-3416
Practice Address - Fax:858-822-1849
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN493755163W00000X
CA8404363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8404OtherNURSE PRACTITIONER LICENS