Basic Information
| Provider Information | |||||||||
| NPI: | 1841422151 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEQUEIRA | ||||||||
| FirstName: | HEIDI | ||||||||
| MiddleName: | RENAE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | CNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FAUL | ||||||||
| OtherFirstName: | HEIDI | ||||||||
| OtherMiddleName: | RENAE | ||||||||
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| OtherCredential: | CNP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1536 HEWITT AVE | ||||||||
| Address2: | MS C1908 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551041205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6515232204 | ||||||||
| FaxNumber: | 6515232820 | ||||||||
| Practice Location | |||||||||
| Address1: | 21785 FILIGREE CT | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ASHBURN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 20147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035541100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2009 | ||||||||
| LastUpdateDate: | 04/16/2014 | ||||||||
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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 | 363LA2100X | R-165141-6 | MN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363LF0000X | R-165141-6 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LP2300X | R-16141-6 | MN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.