Provider Demographics
NPI:1134312747
Name:JAYNES, HEATHER M (CNNP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:JAYNES
Suffix:
Gender:F
Credentials:CNNP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:A
Other - Last Name:MANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2910 CENTRE POINTE DR
Mailing Address - Street 2:MAIL STOP 35-121A
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1182
Mailing Address - Country:US
Mailing Address - Phone:651-855-2327
Mailing Address - Fax:651-855-2310
Practice Address - Street 1:347 NORTH SMITH AVENUE
Practice Address - Street 2:CHILDRENS SPECIALTY CLINIC NICU
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-220-6210
Practice Address - Fax:651-220-7777
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1533356363LN0000X, 363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care