Provider Demographics
NPI:1811437379
Name:HELLER, LYNEA (LPN)
Entity type:Individual
Prefix:
First Name:LYNEA
Middle Name:
Last Name:HELLER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17158 HAMANN ST
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-6610
Mailing Address - Country:US
Mailing Address - Phone:734-444-1416
Mailing Address - Fax:
Practice Address - Street 1:17158 HAMANN ST
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-6610
Practice Address - Country:US
Practice Address - Phone:734-444-1416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-03
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703112196164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse