Provider Demographics
NPI:1770189813
Name:HECKER, LYNELLE KAYE
Entity Type:Individual
Prefix:MRS
First Name:LYNELLE
Middle Name:KAYE
Last Name:HECKER
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 1:552 2ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-6007
Mailing Address - Country:US
Mailing Address - Phone:701-690-6531
Mailing Address - Fax:
Practice Address - Street 1:552 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-6007
Practice Address - Country:US
Practice Address - Phone:701-690-6531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant