Provider Demographics
NPI:1912189549
Name:CAUDLE, HEIDI A (BA)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:A
Last Name:CAUDLE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 COTTAGE HEIGHTS LOOP
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-2758
Mailing Address - Country:US
Mailing Address - Phone:541-206-8157
Mailing Address - Fax:
Practice Address - Street 1:525 S 57TH PL
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97478-5410
Practice Address - Country:US
Practice Address - Phone:541-746-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion