Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 7912 | NE |
NPI | 1023547858 |
---|---|
Provider Name | Jace Joseph Heiden |
First Address | Omaha, NE 68105-1104 |
Second Address | Omaha, NE 68198-1080 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2017 |
Last Update Date | 06/06/2017 |