MEDICARE: BIRGIT MARTHA HEEREN CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	CP000440	SD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
12	P00622980	OTHER	SD	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	370624200	OTHER	SD	DEPT OF LABOR
2	1073564019	OTHER		ARAZ/AMERICA'S PPO
3	76L99HE	OTHER	MN	BLUE CROSS
4	4992421	OTHER	SD	BLUE CROSS
5	76L99HE	OTHER		CC SYSTEMS BLUE PLUS
6	92411422905	OTHER	MN	PRIMEWEST
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	407141053835	OTHER		PREFERRED ONE
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	57105W013	OTHER		WPS TRICARE
11	9255777	OTHER		DAKOTACARE
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	HP86459	OTHER		HEALTHPARTNERS

General Provider Information

NPI Number	:	1073564019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BIRGIT MARTHA HEEREN CNP

Provider Business Mailing Address
First Line	:	PO BOX 86370
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57118-6370
Country	:	US
Telephone Number	:	605-322-6408
Fax Number	:	605-322-4995

Provider Business Practice Location Address
First Line	:	1301 S CLIFF AVE
Second Line	:	STE. 601
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-1005
Country	:	US
Telephone Number	:	605-322-6930
Fax Number	:	605-322-6931

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	10/15/2018

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