Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | VP003622P | PA |
NPI | 1134179278 |
---|---|
Provider Name | Mark Heimann |
First Address | Phila, PA 19107 |
Second Address | Norristown, PA 19401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 25/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VP003622P | CRNP LICENSE (01) | PA |