Individual
BARBARA HEENAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2522 NILES AVE, ST JOSEPH, MI 49085
(269) 983-3364
Mailing address
PO BOX 480, LAKESIDE HEATLHCARE SPECIALISTS, ST JOSEPH, MI 49085
(269) 983-8900
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704096337
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0A110280
BCBS
MI
01
—
500011564
RAIL ROAD MEDICARE
MI
Enumeration date
10/04/2006
Last updated
01/12/2010
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