Healthcare Provider Details

I. General information

NPI: 1023748837
Provider Name (Legal Business Name): HEIDI NEMETH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 BECK AVE
FAIRFIELD CA
94533-6804
US

IV. Provider business mailing address

2840 CLARENCE LN
FAIRFIELD CA
94533-7106
US

V. Phone/Fax

Practice location:
  • Phone: 707-784-8654
  • Fax: 707-421-6618
Mailing address:
  • Phone: 520-895-9497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95101857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: