1699796912 NPI number — MS. ELIZABETH MELVIN HEISE MS, CGC

Table of content: MS. ELIZABETH MELVIN HEISE MS, CGC (NPI 1699796912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699796912 NPI number — MS. ELIZABETH MELVIN HEISE MS, CGC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEISE
Provider First Name:
ELIZABETH
Provider Middle Name:
MELVIN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS, CGC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MELVIN
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
COURTNEY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1699796912
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19 FALLING WATER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27713-7729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-423-5344
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 FALLING WATER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27713-7729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-423-5344
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 170300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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