Individual
KYRIE HEYDENBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1215 E MICHIGAN AVE, LANSING, MI 48912-1811
(517) 364-2616
(517) 364-3525
Mailing address
PO BOX 13008, LANSING, MI 48901-3008
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
60068
CA
363AS0400X
Surgical Physician Assistant
Primary
5601012432
MI
363AS0400X
Surgical Physician Assistant
60068
CA
Other
Enumeration date
08/16/2021
Last updated
02/13/2025
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