Provider Demographics
NPI:1073564019
Name:HEEREN, BIRGIT MARTHA (CNP)
Entity Type:Individual
Prefix:
First Name:BIRGIT
Middle Name:MARTHA
Last Name:HEEREN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-6408
Mailing Address - Fax:605-322-4995
Practice Address - Street 1:1301 S CLIFF AVE
Practice Address - Street 2:STE. 601
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1005
Practice Address - Country:US
Practice Address - Phone:605-322-6930
Practice Address - Fax:605-322-6931
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000440363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD370624200OtherDEPT OF LABOR
1073564019OtherARAZ/AMERICA'S PPO
MN76L99HEOtherBLUE CROSS
SD4992421OtherBLUE CROSS
76L99HEOtherCC SYSTEMS BLUE PLUS
MN92411422905OtherPRIMEWEST
IA2920926Medicaid
407141053835OtherPREFERRED ONE
MN298415600Medicaid
57105W013OtherWPS TRICARE
9255777OtherDAKOTACARE
SDP00622980OtherRR MEDICARE
SD6828542Medicaid
HP86459OtherHEALTHPARTNERS
SDS102279Medicare PIN