1659536548 NPI number — SUSAN A. HEYING RN, CFNP

Table of content: DR. CHARLES UJAY GBADOUWEY MD (NPI 1043255177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659536548 NPI number — SUSAN A. HEYING RN, CFNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEYING
Provider First Name:
SUSAN
Provider Middle Name:
A.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, CFNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OSTENDORF
Provider Other First Name:
SUSAN
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659536548
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1520 WHITNEY COURT
Provider Second Line Business Mailing Address:
CENTRA CARE CLINIC-HEARTLAND
Provider Business Mailing Address City Name:
ST CLOUD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56303-1899
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-251-1775
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1360 ELM ST E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT JOSEPH
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56374-4694
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-363-1745
Provider Business Practice Location Address Fax Number:
320-363-0031
Provider Enumeration Date:
07/21/2008

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: 363LF0000X , with the licence number:  R 121187 2 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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