Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | A086912 | IA |
N | 363LP0200X | Nurse Practitioner - Pediatrics | 34 | WI |
NPI | 1013912559 |
---|---|
Provider Name | Kristen J Heffern |
First Address | Decorah, IA 52101-2325 |
Second Address | Saint Cloud, MN 56301-9668 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2005 |
Last Update Date | 26/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
43832300 | (05) | WI |
P68333 | (02) |