Provider Demographics
NPI:1720123813
Name:MEYERS, HEIDI M
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:M
Last Name:MEYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NE
Mailing Address - Zip Code:68787-1924
Mailing Address - Country:US
Mailing Address - Phone:402-375-5741
Mailing Address - Fax:402-375-3879
Practice Address - Street 1:219 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NE
Practice Address - Zip Code:68787-1924
Practice Address - Country:US
Practice Address - Phone:402-375-5741
Practice Address - Fax:402-375-3879
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE47074699080171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47074699080Medicaid