Provider Demographics
NPI:1174139950
Name:HEARTLAND HEALTHCARE PSYCHIATRY, LLC
Entity type:Organization
Organization Name:HEARTLAND HEALTHCARE PSYCHIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR. ROBERT DETLEFSEN, DNP
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:DETLEFSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FPMH-NP, BC
Authorized Official - Phone:319-471-2479
Mailing Address - Street 1:455 N ORTHMCKENZIE LANE
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-8901
Mailing Address - Country:US
Mailing Address - Phone:319-471-2479
Mailing Address - Fax:877-756-4974
Practice Address - Street 1:455 N ORTHMCKENZIE LANE
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-8901
Practice Address - Country:US
Practice Address - Phone:319-471-2479
Practice Address - Fax:877-756-4974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty