Healthcare Provider Details

I. General information

NPI: 1831877927
Provider Name (Legal Business Name): RICHARD WILLIAM HEUERMANN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2023
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 HAIRPIN DRIVE ALUMNI HALL ROOM 2117
EDWARDSVILLE IL
62026-0001
US

IV. Provider business mailing address

627 LOGAN VALLEY DR
SAINT PETERS MO
63376-3799
US

V. Phone/Fax

Practice location:
  • Phone: 618-650-5688
  • Fax:
Mailing address:
  • Phone: 636-279-0381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2024020452
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: