Provider Demographics
NPI:1598997785
Name:HEYEN, RACHELLE A (MNA, APRN)
Entity Type:Individual
Prefix:MS
First Name:RACHELLE
Middle Name:A
Last Name:HEYEN
Suffix:
Gender:F
Credentials:MNA, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1923 1/2 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-7522
Mailing Address - Country:US
Mailing Address - Phone:801-298-4955
Mailing Address - Fax:
Practice Address - Street 1:1923 1/2 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-7522
Practice Address - Country:US
Practice Address - Phone:801-298-4955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT210158-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health