Provider Demographics
NPI:1780160416
Name:HEINSOHN, BETTINA L (CRNP)
Entity type:Individual
Prefix:
First Name:BETTINA
Middle Name:L
Last Name:HEINSOHN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 KEYSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-8982
Mailing Address - Country:US
Mailing Address - Phone:570-544-1635
Mailing Address - Fax:
Practice Address - Street 1:1201 KEYSTONE BLVD
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-8982
Practice Address - Country:US
Practice Address - Phone:570-544-1635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000000363LF0000X
PASP019046363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily