Provider Demographics
NPI:1598881252
Name:PUCEL, HEIDI MARIE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:MARIE
Last Name:PUCEL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14655 GALAXIE AVE
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124
Mailing Address - Country:US
Mailing Address - Phone:952-432-6161
Mailing Address - Fax:952-432-7019
Practice Address - Street 1:920 E 28TH ST
Practice Address - Street 2:STE 180
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1139
Practice Address - Country:US
Practice Address - Phone:612-338-1100
Practice Address - Fax:612-871-9580
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN133508 8163W00000X
MN4483363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN133508 8OtherREGISTERED NURSE