Provider Demographics
NPI:1639321961
Name:HEINZE, PAULA LEE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:LEE
Last Name:HEINZE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:PSULA
Other - Middle Name:LEE
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:108 MEADOW LANE DR
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-9653
Mailing Address - Country:US
Mailing Address - Phone:315-672-8253
Mailing Address - Fax:
Practice Address - Street 1:108 MEADOW LANE DR
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-9653
Practice Address - Country:US
Practice Address - Phone:315-672-8253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250225-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse