Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | NP18674 | CA |
NPI | 1003112525 |
---|---|
Provider Name | Amina Michelle Heise |
First Address | San Diego, CA 92123-4800 |
Second Address | San Diego, CA 92123-2758 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2011 |
Last Update Date | 31/01/2011 |