Provider Demographics
NPI:1689920266
Name:HEINEMANN, NAOMI (RN, CCRN, FNP)
Entity type:Individual
Prefix:MRS
First Name:NAOMI
Middle Name:
Last Name:HEINEMANN
Suffix:
Gender:F
Credentials:RN, CCRN, FNP
Other - Prefix:
Other - First Name:NAOMI
Other - Middle Name:
Other - Last Name:LOUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1075 OCEAN PARKWAY
Mailing Address - Street 2:APT. 5F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230
Mailing Address - Country:US
Mailing Address - Phone:917-593-6871
Mailing Address - Fax:
Practice Address - Street 1:4802 10TH AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219
Practice Address - Country:US
Practice Address - Phone:718-283-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337014-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine