Basic Information
| Provider Information | |||||||||
| NPI: | 1629533138 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEINZ | ||||||||
| FirstName: | JUSTIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2401 DEMERS AVE | ||||||||
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| City: | GRAND FORKS | ||||||||
| State: | ND | ||||||||
| PostalCode: | 582014183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7017801891 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1200 S COLUMBIA RD | ||||||||
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| City: | GRAND FORKS | ||||||||
| State: | ND | ||||||||
| PostalCode: | 582014036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7017805000 | ||||||||
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| ProviderEnumerationDate: | 02/08/2019 | ||||||||
| LastUpdateDate: | 02/08/2019 | ||||||||
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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 | R38033 | ND | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.