Provider Demographics
NPI:1508195074
Name:HEIN, JUSTINE MARIE (RN,BSN,CWOCN,CFCN)
Entity Type:Individual
Prefix:MRS
First Name:JUSTINE
Middle Name:MARIE
Last Name:HEIN
Suffix:
Gender:F
Credentials:RN,BSN,CWOCN,CFCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 MILL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-5802
Mailing Address - Country:US
Mailing Address - Phone:423-863-3805
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7430
Practice Address - Country:US
Practice Address - Phone:423-844-4405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-13
Last Update Date:2009-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000054163163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care