Provider Demographics
NPI:1407616782
Name:RUNDGREN, HEATHER REANE (RNFA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:REANE
Last Name:RUNDGREN
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:REANE
Other - Last Name:SCHIMMEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2840 ZAPATA CT
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-1756
Mailing Address - Country:US
Mailing Address - Phone:805-791-5390
Mailing Address - Fax:
Practice Address - Street 1:2975 SYCAMORE DR
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1201
Practice Address - Country:US
Practice Address - Phone:805-955-6250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95777221163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant