Provider Demographics
NPI:1487895397
Name:HEINEMAN, DEBORAH MARIE (LVN)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:MARIE
Last Name:HEINEMAN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26182 PALMETTO PL
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-5261
Mailing Address - Country:US
Mailing Address - Phone:949-582-9200
Mailing Address - Fax:
Practice Address - Street 1:26182 PALMETTO PL
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-5261
Practice Address - Country:US
Practice Address - Phone:949-582-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN194576164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse