Provider Demographics
NPI:1750452157
Name:HEISLER, SHANA ELIZABETH MCVEIGH
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:ELIZABETH MCVEIGH
Last Name:HEISLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21410 136TH AVE NORTH SUITE #109
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374
Mailing Address - Country:US
Mailing Address - Phone:763-428-2217
Mailing Address - Fax:763-428-8586
Practice Address - Street 1:21410 136TH AVE NORTH SUITE #109
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374
Practice Address - Country:US
Practice Address - Phone:763-428-2217
Practice Address - Fax:763-428-8586
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND10892122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist