Provider Demographics
NPI:1407801806
Name:HEINTZELMAN, ANN BERNADETTE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:BERNADETTE
Last Name:HEINTZELMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34002 243RD ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:KS
Mailing Address - Zip Code:66020-7119
Mailing Address - Country:US
Mailing Address - Phone:913-773-8652
Mailing Address - Fax:
Practice Address - Street 1:4101 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5014
Practice Address - Country:US
Practice Address - Phone:913-682-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45328363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS45328OtherADVANCED NURSE PRACTITION