Individual
REBECCA HEISINGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
625 E BROADWAY AVE, JACKSON, WY 83001-8642
(307) 739-7218
(307) 739-7446
Mailing address
PO BOX 428, JACKSON, WY 83001-0428
(307) 739-7218
(307) 739-7446
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
39663.1621
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
146914200
—
WY
Enumeration date
12/27/2016
Last updated
02/10/2021
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