Provider Demographics
NPI:1255608733
Name:SANNES, HEIDI JUNE (RN CNP)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:JUNE
Last Name:SANNES
Suffix:
Gender:F
Credentials:RN CNP
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:JUNE
Other - Last Name:HEDLUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 E 28TH ST STE 503
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-3723
Mailing Address - Country:US
Mailing Address - Phone:612-863-4502
Mailing Address - Fax:
Practice Address - Street 1:800 E 28TH ST STE 503
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3723
Practice Address - Country:US
Practice Address - Phone:612-863-4502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 166446-1163W00000X
MNF0811183363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN500007221Medicare PIN