Provider Demographics
NPI:1710040514
Name:HEIT, ELLEN F (NP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:F
Last Name:HEIT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:HONOR
Mailing Address - State:MI
Mailing Address - Zip Code:49640-0366
Mailing Address - Country:US
Mailing Address - Phone:231-325-2277
Mailing Address - Fax:231-325-2279
Practice Address - Street 1:10524 MAIN ST
Practice Address - Street 2:
Practice Address - City:HONOR
Practice Address - State:MI
Practice Address - Zip Code:49640-9461
Practice Address - Country:US
Practice Address - Phone:231-325-2277
Practice Address - Fax:231-325-2279
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704148935363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4627730Medicaid
MI5008769510OtherBCBS
MIP00362705OtherRAILROAD MEDICARE
MI233967Medicare Oscar/Certification
S42682Medicare UPIN
MI4627730Medicaid
MI5008769510OtherBCBS