Basic Information
| Provider Information | |||||||||
| NPI: | 1457474140 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEIDT | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | RN, CNS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3333 BURNET AVE. | ||||||||
| Address2: | ML 5021 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452293039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136367567 | ||||||||
| FaxNumber: | 8664224002 | ||||||||
| Practice Location | |||||||||
| Address1: | 3333 BURNET AVE. | ||||||||
| Address2: | ML 5026 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452293039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136368788 | ||||||||
| FaxNumber: | 5136363737 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2007 | ||||||||
| LastUpdateDate: | 11/02/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SP0807X | COA 0229 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Child & Adolescent |
No ID Information.