Provider Demographics
NPI:1700335452
Name:HEILIG, JENNINGS (CRNA)
Entity type:Individual
Prefix:
First Name:JENNINGS
Middle Name:
Last Name:HEILIG
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 542
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24212-0542
Mailing Address - Country:US
Mailing Address - Phone:540-818-9481
Mailing Address - Fax:
Practice Address - Street 1:17175 RICH VALLEY RD
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2187
Practice Address - Country:US
Practice Address - Phone:540-818-9481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-22
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001207686163W00000X
AZCRNA1393367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse