| NPI | 1710696919 |
|---|---|
| Former Name | SHJADE HEUTZENROEDER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: SD CP002571) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN 10387) |
| Enumeration Date | 2022-11-16 |
| Last Update Date | 2025-05-28 |