1245406453 NPI number — MRS. LIZA MARIE O HEIMANN NP

Table of content: MRS. LIZA MARIE O HEIMANN NP (NPI 1245406453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245406453 NPI number — MRS. LIZA MARIE O HEIMANN NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEIMANN
Provider First Name:
LIZA MARIE
Provider Middle Name:
O
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ORTILLO
Provider Other First Name:
LIZA MARIE
Provider Other Middle Name:
O
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245406453
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 BARNES JEWISH HOSPITAL PLZ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63110-1003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-454-8134
Provider Business Mailing Address Fax Number:
314-454-8180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 BARNES JEWISH HOSPITAL PLZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63110-1003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-454-8134
Provider Business Practice Location Address Fax Number:
314-454-8180
Provider Enumeration Date:
05/07/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  2002008550 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LA2200X , with the licence number: 2002008550 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)