Healthcare Provider Details

I. General information

NPI: 1336683127
Provider Name (Legal Business Name): HEIDI MIESS-GLADDING NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2016
Last Update Date: 12/26/2023
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S PARK ST
MADISON WI
53715-1830
US

IV. Provider business mailing address

2187 COLLADAY POINT DR
STOUGHTON WI
53589-3076
US

V. Phone/Fax

Practice location:
  • Phone: 608-258-6831
  • Fax: 608-258-6340
Mailing address:
  • Phone: 608-334-1564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number115754030
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number621333
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: