Provider Demographics
NPI:1093852972
Name:ZYWIEC, HEIDI M (PA-C)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:M
Last Name:ZYWIEC
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 FALLBROOK BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-4637
Mailing Address - Country:US
Mailing Address - Phone:402-441-3575
Mailing Address - Fax:402-438-2107
Practice Address - Street 1:755 FALLBROOK BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-4637
Practice Address - Country:US
Practice Address - Phone:402-441-3575
Practice Address - Fax:402-438-2107
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1295363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENA1941008Medicare PIN
NE1003OtherTEMP STATE LICENSE NUMBER