Individual
HEIDI LYNNE DATEMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4499 SUMMIT FOREST DR NE, ROCKFORD, MI 49341-7842
(847) 302-6995
Mailing address
4499 SUMMIT FOREST DR NE, ROCKFORD, MI 49341-7842
(847) 302-6995
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703110270
MI
Other
Enumeration date
05/05/2020
Last updated
05/05/2020
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