Provider Demographics
NPI:1740869965
Name:HEINY, EILEEN SUSAN
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:SUSAN
Last Name:HEINY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15412 SILVAN GLEN DR
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22025-1012
Mailing Address - Country:US
Mailing Address - Phone:845-988-6605
Mailing Address - Fax:
Practice Address - Street 1:15412 SILVAN GLEN DR
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22025-1012
Practice Address - Country:US
Practice Address - Phone:845-988-6605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program