Healthcare Provider Details

I. General information

NPI: 1417687138
Provider Name (Legal Business Name): ENVISION PAIN MANAGEMENT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 W SHORE DR
DELAFIELD WI
53018-1226
US

IV. Provider business mailing address

1615 W SHORE DR
DELAFIELD WI
53018-1226
US

V. Phone/Fax

Practice location:
  • Phone: 828-237-8001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SHAUNA HECKER
Title or Position: MANAGING DIRECTOR & COO
Credential:
Phone: 828-237-8001