Provider Demographics
NPI:1689169203
Name:ESSLIN, HEATHER EVELINA (LPN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:EVELINA
Last Name:ESSLIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:EVELINA
Other - Last Name:PURCHASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 E PARIS AVE SE STE 215&214
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3691
Mailing Address - Country:US
Mailing Address - Phone:616-301-8000
Mailing Address - Fax:
Practice Address - Street 1:1000 E PARIS AVE SE STE 215&214
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3691
Practice Address - Country:US
Practice Address - Phone:616-301-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703108765164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse