1205496189 NPI number — HEATHER KIRCHMEIER R.N.

Table of content: DR. LISA GISCHE PH.D. (NPI 1508196536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205496189 NPI number — HEATHER KIRCHMEIER R.N.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIRCHMEIER
Provider First Name:
HEATHER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
R.N.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RODRIGUEZ
Provider Other First Name:
HEATHER
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205496189
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
620 S 400 E SUITE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST. GEORGE
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-673-3528
Provider Business Mailing Address Fax Number:
435-628-6425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
260 E D.L. SARGENT DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-586-2437
Provider Business Practice Location Address Fax Number:
435-586-4851
Provider Enumeration Date:
06/13/2019

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: 163W00000X , with the licence number:  6574060-3102 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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