Provider Demographics
NPI:1851360838
Name:VENEZIA HEUER, VANESSA A (MD)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:A
Last Name:VENEZIA HEUER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1195 GILMORE TRL
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99712-2104
Mailing Address - Country:US
Mailing Address - Phone:907-322-3139
Mailing Address - Fax:
Practice Address - Street 1:8565 POPLAR WAY
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80130-3602
Practice Address - Country:US
Practice Address - Phone:720-348-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI124212084P0804X
CO679112084P0804X
AK62772084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
0361450001Medicare NSC