Provider Demographics
NPI:1194512194
Name:KAPUSTKA, HEATHER LEIGH
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEIGH
Last Name:KAPUSTKA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48811-9460
Mailing Address - Country:US
Mailing Address - Phone:517-526-1132
Mailing Address - Fax:
Practice Address - Street 1:213 N 1ST ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:MI
Practice Address - Zip Code:48811-9460
Practice Address - Country:US
Practice Address - Phone:517-526-1132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula