Provider Demographics
NPI:1538598834
Name:HEINEMANN, JENNIFER SUZANNE (RN, BSN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUZANNE
Last Name:HEINEMANN
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:SUZANNE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3550 MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1089
Mailing Address - Country:US
Mailing Address - Phone:413-858-7400
Mailing Address - Fax:413-746-0380
Practice Address - Street 1:3550 MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1089
Practice Address - Country:US
Practice Address - Phone:413-858-7400
Practice Address - Fax:413-746-0380
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2279928364SC1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health