Healthcare Provider Details

I. General information

NPI: 1740568914
Provider Name (Legal Business Name): VINEKA HEERAMUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8846 S REDWOOD RD STE N202
WEST JORDAN UT
84088-4702
US

IV. Provider business mailing address

13894 S BANGERTER PKWY STE 200
DRAPER UT
84020-5320
US

V. Phone/Fax

Practice location:
  • Phone: 801-618-4303
  • Fax:
Mailing address:
  • Phone: 801-618-4303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9603896
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125060306
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number9603896
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number125060306
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: