Provider Demographics
NPI:1225277197
Name:HEIMER, BRENDA ELAINE (RT, RDMS, RVT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:ELAINE
Last Name:HEIMER
Suffix:
Gender:F
Credentials:RT, RDMS, RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8420 PLUM RUN DR
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172-9068
Mailing Address - Country:US
Mailing Address - Phone:812-248-4770
Mailing Address - Fax:
Practice Address - Street 1:200 ABRAHAM FLEXNER WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2877
Practice Address - Country:US
Practice Address - Phone:502-587-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN227658247100000X
MD275052471S1302X, 2471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography