Provider Demographics
NPI:1245406453
Name:HEIMANN, LIZA MARIE O (NP)
Entity Type:Individual
Prefix:MRS
First Name:LIZA MARIE
Middle Name:O
Last Name:HEIMANN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:LIZA MARIE
Other - Middle Name:O
Other - Last Name:ORTILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1 BARNES JEWISH HOSPITAL PLZ
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1003
Mailing Address - Country:US
Mailing Address - Phone:314-454-8134
Mailing Address - Fax:314-454-8180
Practice Address - Street 1:1 BARNES JEWISH HOSPITAL PLZ
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1003
Practice Address - Country:US
Practice Address - Phone:314-454-8134
Practice Address - Fax:314-454-8180
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002008550363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health