Provider Demographics
NPI:1285020743
Name:HECKENBERG, NASIM
Entity type:Individual
Prefix:DR
First Name:NASIM
Middle Name:
Last Name:HECKENBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NASIM
Other - Middle Name:
Other - Last Name:POURTABATABAEI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1221 S GEAR AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1679
Mailing Address - Country:US
Mailing Address - Phone:319-768-3265
Mailing Address - Fax:
Practice Address - Street 1:1221 S GEAR AVE
Practice Address - Street 2:
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1679
Practice Address - Country:US
Practice Address - Phone:319-768-3265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-11
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA45687208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist