Provider Demographics
NPI:1982098984
Name:KIMMER, HEIDI (LAC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:KIMMER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5625 KNOX AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-1505
Mailing Address - Country:US
Mailing Address - Phone:612-227-2285
Mailing Address - Fax:
Practice Address - Street 1:5625 KNOX AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55419-1505
Practice Address - Country:US
Practice Address - Phone:612-227-2285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1644171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist