Provider Demographics
NPI:1497116750
Name:HEISCHMIDT, WHITNEY E (CRNA)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:E
Last Name:HEISCHMIDT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2600 E B STREET RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-4205
Mailing Address - Country:US
Mailing Address - Phone:618-367-4280
Mailing Address - Fax:
Practice Address - Street 1:4500 MEMORIAL DRIVE
Practice Address - Street 2:MEMORIAL HOSPITAL ANESTHESIA DEPT
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226
Practice Address - Country:US
Practice Address - Phone:618-257-5162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013845367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered