Provider Demographics
NPI:1639416233
Name:HEILIG, ANDREA GAIL
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:GAIL
Last Name:HEILIG
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ANDREA
Other - Middle Name:GAIL
Other - Last Name:CRAFTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 412
Mailing Address - Street 2:
Mailing Address - City:FAIRLAND
Mailing Address - State:OK
Mailing Address - Zip Code:74343-0412
Mailing Address - Country:US
Mailing Address - Phone:918-541-4539
Mailing Address - Fax:
Practice Address - Street 1:17794 SOUTH 580 ROAD
Practice Address - Street 2:
Practice Address - City:FAIRLAND
Practice Address - State:OK
Practice Address - Zip Code:74343
Practice Address - Country:US
Practice Address - Phone:918-452-3335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKS081307288171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator