Provider Demographics
NPI:1336865864
Name:HEINEN, CATHRYN JOHN (PA-C)
Entity Type:Individual
Prefix:
First Name:CATHRYN
Middle Name:JOHN
Last Name:HEINEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CATHRYN
Other - Middle Name:JOHN
Other - Last Name:YAGGIE HEINEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3107 DOLORES DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-0426
Mailing Address - Country:US
Mailing Address - Phone:320-333-4709
Mailing Address - Fax:
Practice Address - Street 1:1301 33RD ST S
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-9668
Practice Address - Country:US
Practice Address - Phone:320-251-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN14260363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical