Provider Demographics
NPI:1952308397
Name:HEYNEN, COURTNEY-MAREE (CNM)
Entity Type:Individual
Prefix:
First Name:COURTNEY-MAREE
Middle Name:
Last Name:HEYNEN
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 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-8919
Practice Address - Street 1:1417 S. CLIFF AVE.
Practice Address - Street 2:STE. 401
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1064
Practice Address - Country:US
Practice Address - Phone:605-322-8920
Practice Address - Fax:605-322-8919
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN160603367A00000X
SDCM000065367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I429644OtherMEDICARE PTAN
GA000972749CMedicaid