Heather Fonville
Individual provider Active NPI Licensed Practical Nurse · New Haven, MI
NPI 1255847893 · NPPES record last updated Dec 19, 2017
Key facts
- NPI
- 1255847893
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- 4703113383 (MI)
- Practice address
- 3201 E. Cranston
New Haven, MI 48048 - Phone
- (586) 873-5213
- NPI assigned
- Dec 19, 2017
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4703113383 | MI | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 4703113383 | MI | Yes |
Addresses
Primary practice location
3201 E. Cranston
New Haven, MI 48048
Mailing address
3201 E. Cranston
New Haven, MI 48048
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 19, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.