# TANYA HEIDENREICH

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1689689085
- **Gender:** F
- **Credential:** CFNP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | NP358A | ID | Yes |

## Other

- **Enumeration date:** 07/31/2006
- **Last updated:** 10/06/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000010015819 | REGENCE BLUE SHIELD | ID |
| 05 | — | 805146700 | — | ID |
| 01 | — | NP659 | BLUE CROSS | ID |