Basic Information
| Provider Information | |||||||||
| NPI: | 1528061942 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEIBEIN | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | WILLIAM | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CRNA, MSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 289 COUNTY RD | ||||||||
| Address2: | |||||||||
| City: | WINDSOR | ||||||||
| State: | VT | ||||||||
| PostalCode: | 050899000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8026747300 | ||||||||
| FaxNumber: | 8026747314 | ||||||||
| Practice Location | |||||||||
| Address1: | 289 COUNTY RD | ||||||||
| Address2: | |||||||||
| City: | WINDSOR | ||||||||
| State: | VT | ||||||||
| PostalCode: | 050899000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8026747300 | ||||||||
| FaxNumber: | 8026747314 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2005 | ||||||||
| LastUpdateDate: | 02/11/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 043575-23-11 | NH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | 1010091185 | VT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 430067345 | 01 | NH | RAIL ROAD MEDICARE | OTHER | 30342168 | 05 | NH | MEDICAID | HEIB29590 | 01 | VT | BCBS OF VERMONT | OTHER | 40Y003605NH01 | 01 | NH | ANTHEM BCBS | OTHER | 0NA0730 | 05 | VT | MEDICAID | 668510 | 01 | NH | CIGNA | OTHER | AA48568 | 01 | NH | HARVARD PILGRAM HEALTH | OTHER |