Basic Information
| Provider Information | |||||||||
| NPI: | 1164056313 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEIMKE | ||||||||
| FirstName: | TAYLOR | ||||||||
| MiddleName: | RENEE | ||||||||
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| Credential: | MSN, APRN, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8820 GARFIELD DR APT 3 | ||||||||
| Address2: | |||||||||
| City: | WHITMORE LAKE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481898239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488607035 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 32255 NORTHWESTERN HWY STE 130 | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483341505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487235880 | ||||||||
| FaxNumber: | 2487235889 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2020 | ||||||||
| LastUpdateDate: | 03/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 4704314198 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.