Provider Demographics
NPI:1770790990
Name:HEITKEMPER, STEPHINE A (ARNP)
Entity type:Individual
Prefix:
First Name:STEPHINE
Middle Name:A
Last Name:HEITKEMPER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 LILLY RD NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5427
Mailing Address - Country:US
Mailing Address - Phone:360-754-9409
Mailing Address - Fax:360-438-6760
Practice Address - Street 1:200 LILLY RD NE
Practice Address - Street 2:BLDG 2
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5427
Practice Address - Country:US
Practice Address - Phone:360-754-9409
Practice Address - Fax:360-438-6760
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30000835363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8603094Medicaid