Provider Demographics
NPI:1659620631
Name:HEINRICH, PATRICIA ANN (CNM)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:HEINRICH
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 1:104 LAKESHORE DR
Mailing Address - Street 2:STE. A
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-3803
Mailing Address - Country:US
Mailing Address - Phone:912-882-7100
Mailing Address - Fax:912-882-9149
Practice Address - Street 1:104 LAKESHORE DR
Practice Address - Street 2:STE. A
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-3803
Practice Address - Country:US
Practice Address - Phone:912-882-7100
Practice Address - Fax:912-882-9149
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN194996367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife