Provider Demographics
NPI:1134193931
Name:HEYOB, CONNIE ELAINE (APRN)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:ELAINE
Last Name:HEYOB
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:ELAINE
Other - Last Name:LIMBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2047 N LAST CHANCE GULCH # 451
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-0744
Mailing Address - Country:US
Mailing Address - Phone:423-742-2456
Mailing Address - Fax:
Practice Address - Street 1:211 W MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST HELENA
Practice Address - State:MT
Practice Address - Zip Code:59635-9012
Practice Address - Country:US
Practice Address - Phone:423-742-2456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16152363LF0000X
TN13904363LF0000X
VA0024170218363LF0000X
MT220285363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I508690Medicare PIN