Provider Demographics
NPI:1851425433
Name:HEISEL, PRISCILLA (PHN III, RN)
Entity Type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:
Last Name:HEISEL
Suffix:
Gender:F
Credentials:PHN III, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6160 MISSION GORGE RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-3410
Mailing Address - Country:US
Mailing Address - Phone:619-528-4048
Mailing Address - Fax:619-528-4087
Practice Address - Street 1:6160 MISSION GORGE RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-3410
Practice Address - Country:US
Practice Address - Phone:619-528-4048
Practice Address - Fax:619-528-4087
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA350102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse