Individual
TANYA HEIDENREICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
2199 W IRONWOOD CENTER DR, COEUR D ALENE, ID 83814-2639
(208) 625-4888
Mailing address
2199 W IRONWOOD CENTER DR, COEUR D ALENE, ID 83814-2639
(208) 625-4888
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP358A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010015819
REGENCE BLUE SHIELD
ID
05
—
805146700
—
ID
01
—
NP659
BLUE CROSS
ID
Enumeration date
07/31/2006
Last updated
10/06/2020
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