Basic Information
| Provider Information | |||||||||
| NPI: | 1578593117 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEYN | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2239 MOUNT CURVE AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT JOSEPH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490852023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2699833184 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5515 CLEVELAND AVE | ||||||||
| Address2: | |||||||||
| City: | STEVENSVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 491279670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2694299644 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 03/14/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 4704100211 | MI | N | Nursing Service Providers | Registered Nurse | 363A00000X | 5601001065 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 970024775 | 01 | MI | RAILROAD MEDICARE | OTHER | MH0920341 | 01 | MI | DEA | OTHER |