Provider Demographics
NPI:1710785035
Name:HEYNE, MINDY SUE
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:SUE
Last Name:HEYNE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8282 RHINE WAY
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-3015
Mailing Address - Country:US
Mailing Address - Phone:937-681-8193
Mailing Address - Fax:
Practice Address - Street 1:8282 RHINE WAY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45458-3015
Practice Address - Country:US
Practice Address - Phone:937-681-8193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0287212376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker