Healthcare Provider Details

I. General information

NPI: 1417878604
Provider Name (Legal Business Name): HEALING HEARTS WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 N BARKER RD STE 6
BROOKFIELD WI
53045-5216
US

IV. Provider business mailing address

1305 N BARKER RD STE 6
BROOKFIELD WI
53045-5216
US

V. Phone/Fax

Practice location:
  • Phone: 414-617-0724
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMY DENNEAU
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 414-617-0724