Individual
BLAKE HEINONEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
903 LINCOLN DR, CONNEAUT, OH 44030-2137
(440) 813-7665
Mailing address
903 LINCOLN DR, CONNEAUT, OH 44030-2137
(440) 813-7665
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.004922RX
OH
Other
Enumeration date
11/21/2016
Last updated
11/21/2016
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