Provider Demographics
NPI:1497384770
Name:VANDERBEEK, HEIDI IRENE
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:IRENE
Last Name:VANDERBEEK
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 1:231 E CAMP ST
Mailing Address - Street 2:
Mailing Address - City:ELY
Mailing Address - State:MN
Mailing Address - Zip Code:55731-1495
Mailing Address - Country:US
Mailing Address - Phone:218-365-4017
Mailing Address - Fax:
Practice Address - Street 1:231 E CAMP ST
Practice Address - Street 2:
Practice Address - City:ELY
Practice Address - State:MN
Practice Address - Zip Code:55731-1495
Practice Address - Country:US
Practice Address - Phone:218-365-4017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker