Provider Demographics
NPI:1558654152
Name:KRAFT, HEIDI M (MSN, PMHNP)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:M
Last Name:KRAFT
Suffix:
Gender:F
Credentials:MSN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1055
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NH
Mailing Address - Zip Code:03048-1055
Mailing Address - Country:US
Mailing Address - Phone:774-225-0075
Mailing Address - Fax:774-225-0075
Practice Address - Street 1:15 MAIN STREET #1055
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NH
Practice Address - Zip Code:03048-1055
Practice Address - Country:US
Practice Address - Phone:774-225-0075
Practice Address - Fax:774-225-0075
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN264523363LP0808X, 390200000X
NH079140-23363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program