Provider Demographics
NPI:1790881332
Name:HEIDMANN, JENNIFER ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANNE
Last Name:HEIDMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6860
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95502-6860
Mailing Address - Country:US
Mailing Address - Phone:707-443-3384
Mailing Address - Fax:707-443-3204
Practice Address - Street 1:1910 CALIFORNIA ST
Practice Address - Street 2:PACE HUMBOLDT RESOURCE CENTER
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501
Practice Address - Country:US
Practice Address - Phone:707-443-9747
Practice Address - Fax:707-443-3204
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA73714207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A727140Medicaid
H69648Medicare UPIN
CA00A727140Medicare PIN