Provider Demographics
NPI:1578197851
Name:MENA, HEATHER BRENEISEN (CNM)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:BRENEISEN
Last Name:MENA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 SHORELY DR
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-3340
Mailing Address - Country:US
Mailing Address - Phone:847-226-9351
Mailing Address - Fax:
Practice Address - Street 1:569 SHORELY DR
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-3340
Practice Address - Country:US
Practice Address - Phone:847-226-9351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO994368367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife