Provider Demographics
NPI:1881074367
Name:HOPPE, HEIDI MARIE (RN, ACNS, PMHNP)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:MARIE
Last Name:HOPPE
Suffix:
Gender:F
Credentials:RN, ACNS, PMHNP
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:MARIE
Other - Last Name:WILDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:42935 QUARTZ RD
Mailing Address - Street 2:
Mailing Address - City:STAPLES
Mailing Address - State:MN
Mailing Address - Zip Code:56479-5169
Mailing Address - Country:US
Mailing Address - Phone:320-493-5487
Mailing Address - Fax:218-894-8205
Practice Address - Street 1:401 PRAIRIE AVE NE
Practice Address - Street 2:
Practice Address - City:STAPLES
Practice Address - State:MN
Practice Address - Zip Code:56479-3201
Practice Address - Country:US
Practice Address - Phone:218-894-8205
Practice Address - Fax:218-894-8218
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNS 0333364SA2200X
MN8169363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health