Healthcare Provider Details

I. General information

NPI: 1558825299
Provider Name (Legal Business Name): JENNIFER L HEIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 6TH AVE S
BIRMINGHAM AL
35233-1932
US

IV. Provider business mailing address

3712 LODGE DR APT F
VESTAVIA HILLS AL
35216-6275
US

V. Phone/Fax

Practice location:
  • Phone: 205-996-4201
  • Fax:
Mailing address:
  • Phone: 256-453-6620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-164524
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number1-164524
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: