Provider Demographics
NPI:1356998215
Name:HEILLE, KATIE MARIE (CNP)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:HEILLE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W FRANKLIN AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-2308
Mailing Address - Country:US
Mailing Address - Phone:952-460-0183
Mailing Address - Fax:
Practice Address - Street 1:305 W FRANKLIN AVE APT 201
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-2308
Practice Address - Country:US
Practice Address - Phone:952-460-0183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-24
Last Update Date:2019-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6233208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics