Provider Demographics
NPI:1982707576
Name:HEIMLICH, DIANE JO (NP APN C)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:JO
Last Name:HEIMLICH
Suffix:
Gender:F
Credentials:NP APN C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 BENNER ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08904
Mailing Address - Country:US
Mailing Address - Phone:732-819-9485
Mailing Address - Fax:
Practice Address - Street 1:61 DUDLEY RD
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-8520
Practice Address - Country:US
Practice Address - Phone:732-932-9805
Practice Address - Fax:732-932-1465
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN07027200363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health