Provider Demographics
NPI:1205107711
Name:HEINTZ, SHANNON KATHLEEN (CD, PCD, CLEC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:KATHLEEN
Last Name:HEINTZ
Suffix:
Gender:F
Credentials:CD, PCD, CLEC
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 378
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27702-0378
Mailing Address - Country:US
Mailing Address - Phone:919-200-0478
Mailing Address - Fax:
Practice Address - Street 1:323 E CHAPEL HILL ST
Practice Address - Street 2:SUITE 378
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27702-2400
Practice Address - Country:US
Practice Address - Phone:919-200-0478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-16
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174H00000XOther Service ProvidersHealth Educator