Healthcare Provider Details

I. General information

NPI: 1255880035
Provider Name (Legal Business Name): NICOLE HEILIGER B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2016
Last Update Date: 09/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 S PARK ST
MADISON WI
53715-1507
US

IV. Provider business mailing address

2 ASHWOOD CT
MADISON WI
53719-5047
US

V. Phone/Fax

Practice location:
  • Phone: 608-417-6000
  • Fax:
Mailing address:
  • Phone: 608-445-4757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: