Basic Information
Provider Information
NPI: 1003294265
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HEUER
FirstName: ALWIN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 300 LONG SHOALS RD APT 7J
Address2:  
City: ARDEN
State: NC
PostalCode: 287047720
CountryCode: US
TelephoneNumber: 2057054425
FaxNumber:  
Practice Location
Address1: 300 LONG SHOALS RD APT 7J
Address2:  
City: ARDEN
State: NC
PostalCode: 287047720
CountryCode: US
TelephoneNumber: 2057054425
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/08/2015
LastUpdateDate: 10/09/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
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AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X695210NYN Nursing Service ProvidersRegistered Nurse 
367500000X077829-23NHY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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