Healthcare Provider Details

I. General information

NPI: 1851360838
Provider Name (Legal Business Name): VANESSA A. VENEZIA HEUER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8565 POPLAR WAY
HIGHLANDS RANCH CO
80130-3602
US

IV. Provider business mailing address

1195 GILMORE TRL
FAIRBANKS AK
99712-2104
US

V. Phone/Fax

Practice location:
  • Phone: 720-348-2800
  • Fax:
Mailing address:
  • Phone: 907-322-3139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number12421
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number67911
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number6277
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: