Provider Demographics
NPI:1437495967
Name:HEINONEN, MCKENSAY ELISABETH (FNP-BC)
Entity type:Individual
Prefix:
First Name:MCKENSAY
Middle Name:ELISABETH
Last Name:HEINONEN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:MCKENSAY
Other - Middle Name:ELISABETH
Other - Last Name:HOURTIENNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:200 JEFFERSON AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4502
Mailing Address - Country:US
Mailing Address - Phone:616-685-6374
Mailing Address - Fax:616-685-6610
Practice Address - Street 1:200 JEFFERSON AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4502
Practice Address - Country:US
Practice Address - Phone:616-685-6374
Practice Address - Fax:616-685-6610
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704245459363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner