Individual
PATRICIA HERON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1091 S BEACON BLVD, GRAND HAVEN, MI 49417-2607
(616) 604-0096
Mailing address
16051 BAIRD DR, SPRING LAKE, MI 49456-2331
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704237156
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4811777
—
MI
01
—
PH237156
BLUE CROSS BLUE SHIELD
—
Enumeration date
08/27/2006
Last updated
06/24/2008
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