Basic Information
| Provider Information | |||||||||
| NPI: | 1073564019 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEEREN | ||||||||
| FirstName: | BIRGIT | ||||||||
| MiddleName: | MARTHA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 86370 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571186370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053226408 | ||||||||
| FaxNumber: | 6053224995 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 S CLIFF AVE | ||||||||
| Address2: | STE. 601 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053226930 | ||||||||
| FaxNumber: | 6053226931 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 10/15/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | CP000440 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 370624200 | 01 | SD | DEPT OF LABOR | OTHER | 1073564019 | 01 | ARAZ/AMERICA'S PPO | OTHER | 76L99HE | 01 | MN | BLUE CROSS | OTHER | 4992421 | 01 | SD | BLUE CROSS | OTHER | 76L99HE | 01 | CC SYSTEMS BLUE PLUS | OTHER | 92411422905 | 01 | MN | PRIMEWEST | OTHER | 2920926 | 05 | IA | MEDICAID | 407141053835 | 01 | PREFERRED ONE | OTHER | 298415600 | 05 | MN | MEDICAID | 57105W013 | 01 | WPS TRICARE | OTHER | 9255777 | 01 | DAKOTACARE | OTHER | P00622980 | 01 | SD | RR MEDICARE | OTHER | 6828542 | 05 | SD | MEDICAID | HP86459 | 01 | HEALTHPARTNERS | OTHER |