Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 02948 | IA |
NPI | 1336239748 |
---|---|
Provider Name | Dr. Verlyn W. Heine |
First Address | Oelwein, IA 50662-1938 |
Second Address | Oelwein, IA 50662-1938 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T00007 | (02) | IA |