Provider Demographics
NPI:1821638255
Name:HEIMBERG, BRANDON NICHOLAS (AEMT)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:NICHOLAS
Last Name:HEIMBERG
Suffix:
Gender:M
Credentials:AEMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 S LAKE PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-8218
Mailing Address - Country:US
Mailing Address - Phone:801-902-4238
Mailing Address - Fax:
Practice Address - Street 1:2500 S LAKE PARK BLVD
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-8218
Practice Address - Country:US
Practice Address - Phone:801-902-4238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2011026018146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic