Provider Demographics
NPI:1396392213
Name:HEIGES, NICOLE LYN
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYN
Last Name:HEIGES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8610 BENT PINE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ANN
Mailing Address - State:MI
Mailing Address - Zip Code:49650-9414
Mailing Address - Country:US
Mailing Address - Phone:231-357-3438
Mailing Address - Fax:
Practice Address - Street 1:13194 S CEDAR RD
Practice Address - Street 2:
Practice Address - City:CEDAR
Practice Address - State:MI
Practice Address - Zip Code:49621-9581
Practice Address - Country:US
Practice Address - Phone:231-835-0693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI821601257164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4703121386OtherNURSING LICENSE