Healthcare Provider Details

I. General information

NPI: 1811842008
Provider Name (Legal Business Name): EMMA ELIZABETH HIETPAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 S ONEIDA ST
APPLETON WI
54915-1305
US

IV. Provider business mailing address

10625 W NORTH AVE STE 101B
WAUWATOSA WI
53226-2315
US

V. Phone/Fax

Practice location:
  • Phone: 414-877-5350
  • Fax:
Mailing address:
  • Phone: 414-877-5350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: