Provider Demographics
NPI:1093801243
Name:HEIMANN, PHYLLIS K (RN CDE)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:K
Last Name:HEIMANN
Suffix:
Gender:F
Credentials:RN CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 NORTH MONITOR STREET
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:NE
Mailing Address - Zip Code:68788-1595
Mailing Address - Country:US
Mailing Address - Phone:402-372-2404
Mailing Address - Fax:402-372-2360
Practice Address - Street 1:430 NORTH MONITOR STREET
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:NE
Practice Address - Zip Code:68788-1595
Practice Address - Country:US
Practice Address - Phone:402-372-2404
Practice Address - Fax:402-372-2360
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE24024163WC1600X, 163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
Provider Identifiers
StateIdentifier IDID TypeIssuer
NED81004OtherBCBS OF NEBRASKA