Healthcare Provider Details

I. General information

NPI: 1174420400
Provider Name (Legal Business Name): KYLA JEAN HEIMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2026
Last Update Date: 10/21/2026
Certification Date: 10/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SCHABOW ST
GRESHAM WI
54128-9505
US

IV. Provider business mailing address

501 SCHABOW ST
GRESHAM WI
54128-9505
US

V. Phone/Fax

Practice location:
  • Phone: 715-787-3211
  • Fax: 715-787-3951
Mailing address:
  • Phone: 715-787-3211
  • Fax: 715-787-3951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number135802-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: