Provider Demographics
NPI:1841422151
Name:SEQUEIRA, HEIDI RENAE (CNP)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:RENAE
Last Name:SEQUEIRA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:RENAE
Other - Last Name:FAUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:1536 HEWITT AVE
Mailing Address - Street 2:MS C1908
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-1205
Mailing Address - Country:US
Mailing Address - Phone:651-523-2204
Mailing Address - Fax:651-523-2820
Practice Address - Street 1:21785 FILIGREE CT
Practice Address - Street 2:SUITE 100
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147
Practice Address - Country:US
Practice Address - Phone:703-554-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-165141-6363LA2100X, 363LF0000X
MNR-16141-6363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care