Provider Demographics
NPI:1649844937
Name:SMITH, HEATHER SHAUF (RN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:SHAUF
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8623 HIGHWAY 63 N
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-3330
Mailing Address - Country:US
Mailing Address - Phone:507-573-2469
Mailing Address - Fax:
Practice Address - Street 1:125 2ND AVE NW
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:MN
Practice Address - Zip Code:55964-1222
Practice Address - Country:US
Practice Address - Phone:507-951-3830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2475442163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse