Provider Demographics
NPI:1982849063
Name:HEITMANN, JULIE IRENE (RN)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:IRENE
Last Name:HEITMANN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:JULIE
Other - Middle Name:IRENE
Other - Last Name:SCHUSTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:100 LAKE TRAVERSE DR
Mailing Address - Street 2:
Mailing Address - City:SISSETON
Mailing Address - State:SD
Mailing Address - Zip Code:57262-7046
Mailing Address - Country:US
Mailing Address - Phone:605-698-7606
Mailing Address - Fax:605-742-0182
Practice Address - Street 1:100 LAKE TRAVERSE DR
Practice Address - Street 2:
Practice Address - City:SISSETON
Practice Address - State:SD
Practice Address - Zip Code:57262-7046
Practice Address - Country:US
Practice Address - Phone:605-698-7606
Practice Address - Fax:605-742-0182
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD-RN R015614163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse