Provider Demographics
NPI:1528397080
Name:SHULISTA, HEIDI NICHOLE (CBE,CD(DONA))
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:NICHOLE
Last Name:SHULISTA
Suffix:
Gender:F
Credentials:CBE,CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E WEA ST
Mailing Address - Street 2:
Mailing Address - City:PAOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66071-1732
Mailing Address - Country:US
Mailing Address - Phone:913-710-4205
Mailing Address - Fax:
Practice Address - Street 1:110 E WEA ST
Practice Address - Street 2:
Practice Address - City:PAOLA
Practice Address - State:KS
Practice Address - Zip Code:66071-1732
Practice Address - Country:US
Practice Address - Phone:913-710-4205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-12
Last Update Date:2009-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula