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General NPI Number Information
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NPI Number | 1760458780
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Entity Type | Individual
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Provider Name | NYLA A HEEREMA PH.D.
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Gender | Female
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Dates
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Enumeration Date | 02/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1645 NEIL AVE 167 HAMILTON HALL
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City | COLUMBUS
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State | OH
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Zip | 43210-1218
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Country | US
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Telephone | 614-292-7815
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Fax | 614-688-8326
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Provider Business Mailing Address
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Address Line | 1645 NEIL AVE 167 HAMILTON HALL
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City | COLUMBUS
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State | OH
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Zip | 43210-1218
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Country | US
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Telephone | 614-292-0714
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Fax | 614-688-8326
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207SC0300X
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Taxonomy Name | Clinical Cytogenetics Physician
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License Number | 1194
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License Number State | OH
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