Healthcare Provider Details

I. General information

NPI: 1548602154
Provider Name (Legal Business Name): KIM MARIE HEIM MSN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 07/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 W EXCHANGE ST STE 160
AKRON OH
44302-1705
US

IV. Provider business mailing address

136 FOX RIDGE WAY
TALLMADGE OH
44278-3918
US

V. Phone/Fax

Practice location:
  • Phone: 330-344-6543
  • Fax:
Mailing address:
  • Phone: 330-630-2591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number244220
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14798
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: