Provider Demographics
NPI:1043266562
Name:HEERMANN, CHANEL MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANEL
Middle Name:MARIE
Last Name:HEERMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:CHANEL
Other - Middle Name:MARIE
Other - Last Name:VANDEWEGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7609 SPRINGFIELD DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-1610
Mailing Address - Country:US
Mailing Address - Phone:308-224-0191
Mailing Address - Fax:
Practice Address - Street 1:UNMC PSYCHIATRY
Practice Address - Street 2:985575 NEBRASKA MEDICAL CENTER
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-0001
Practice Address - Country:US
Practice Address - Phone:402-552-6002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ312322084P0800X
NE236892084P0800X
CODR.00441712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ777849-03Medicaid
AZ777849-03Medicaid