Provider Demographics
NPI:1548133481
Name:HEYEN, ANN ELIZABETH (MS RDN LDN)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:ELIZABETH
Last Name:HEYEN
Suffix:
Gender:F
Credentials:MS RDN LDN
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:ELIZABETH
Other - Last Name:MALLON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS RDN LDN
Mailing Address - Street 1:876 KING RD APT A
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-2200
Mailing Address - Country:US
Mailing Address - Phone:314-252-8555
Mailing Address - Fax:
Practice Address - Street 1:11141 QUEENSWAY DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-4975
Practice Address - Country:US
Practice Address - Phone:314-252-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-26
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.11116133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered