Individual
MARY ANN HEINICKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN CNNP
Contact information
Practice address
1200 SIXTH AVE N, CENTRACARE CLINIC, ST CLOUD, MN 56303-2735
(320) 251-2700
Mailing address
1200 SIXTH AVE N, CENTRACARE CLINIC, ST CLOUD, MN 56303-2735
(320) 251-2700
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
R097601-1
MN
Other
Enumeration date
08/06/2010
Last updated
11/06/2012
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