Provider Demographics
NPI:1205119559
Name:HEIM, SHAWYNE LATRICE (REGISTER NURSE)
Entity type:Individual
Prefix:MS
First Name:SHAWYNE
Middle Name:LATRICE
Last Name:HEIM
Suffix:
Gender:F
Credentials:REGISTER NURSE
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 750220
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70175-0220
Mailing Address - Country:US
Mailing Address - Phone:504-452-8227
Mailing Address - Fax:
Practice Address - Street 1:11000 N HARDY ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-2838
Practice Address - Country:US
Practice Address - Phone:504-452-8227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN127179163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse