Provider Demographics
NPI:1518548858
Name:STUBER, HEATHER (PMHNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:STUBER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 S POKEGAMA AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-3820
Mailing Address - Country:US
Mailing Address - Phone:218-327-2001
Mailing Address - Fax:218-327-0456
Practice Address - Street 1:516 S POKEGAMA AVE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-3820
Practice Address - Country:US
Practice Address - Phone:218-327-2001
Practice Address - Fax:218-327-0456
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8142363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health