Healthcare Provider Details

I. General information

NPI: 1376355362
Provider Name (Legal Business Name): HEIDI MARIE NEUHAUSER APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEIDI MARIE BRUFLAT

II. Dates (important events)

Enumeration Date: 01/25/2025
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 S UNIVERSITY AVE
BEAVER DAM WI
53916-3027
US

IV. Provider business mailing address

1000 N OAK AVE
MARSHFIELD WI
54449-5703
US

V. Phone/Fax

Practice location:
  • Phone: 920-887-7181
  • Fax:
Mailing address:
  • Phone: 715-387-5511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16109
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number1610933
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: