Provider Demographics
NPI:1891042644
Name:HEYLEN, MARIE-PAULE SIMONE (ANP-C)
Entity Type:Individual
Prefix:MRS
First Name:MARIE-PAULE
Middle Name:SIMONE
Last Name:HEYLEN
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6805 US HIGHWAY 11
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-3131
Mailing Address - Country:US
Mailing Address - Phone:315-265-3105
Mailing Address - Fax:315-265-0323
Practice Address - Street 1:6805 US HIGHWAY 11
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-3131
Practice Address - Country:US
Practice Address - Phone:315-265-3105
Practice Address - Fax:315-265-0323
Is Sole Proprietor?:No
Enumeration Date:2012-08-11
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF306058-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03497023Medicaid
NY56913AMedicare UPIN