Healthcare Provider Details

I. General information

NPI: 1922932995
Provider Name (Legal Business Name): HEATHER WARAX RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S ALMON ST
BOWLER WI
54416-9745
US

IV. Provider business mailing address

1216 S ANDREWS ST
SHAWANO WI
54166-3408
US

V. Phone/Fax

Practice location:
  • Phone: 715-793-4101
  • Fax:
Mailing address:
  • Phone: 920-471-6702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number1100443-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: