Provider Demographics
NPI:1821514746
Name:HEINZE, COLLEEN PATRICIA (CNM)
Entity Type:Individual
Prefix:MISS
First Name:COLLEEN
Middle Name:PATRICIA
Last Name:HEINZE
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:PO BOX 405
Mailing Address - Street 2:
Mailing Address - City:RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:11961-0405
Mailing Address - Country:US
Mailing Address - Phone:631-486-0832
Mailing Address - Fax:631-504-0723
Practice Address - Street 1:36 E 2ND ST
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-4731
Practice Address - Country:US
Practice Address - Phone:631-486-0832
Practice Address - Fax:631-504-0723
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001814176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife