Provider Demographics
NPI:1760458780
Name:HEEREMA, NYLA A (PHD)
Entity Type:Individual
Prefix:DR
First Name:NYLA
Middle Name:A
Last Name:HEEREMA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1645 NEIL AVE
Mailing Address - Street 2:167 HAMILTON HALL
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-1218
Mailing Address - Country:US
Mailing Address - Phone:614-292-0714
Mailing Address - Fax:614-688-8326
Practice Address - Street 1:1645 NEIL AVE
Practice Address - Street 2:167 HAMILTON HALL
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1218
Practice Address - Country:US
Practice Address - Phone:614-292-7815
Practice Address - Fax:614-688-8326
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH1194207SC0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SC0300XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Cytogenetics