Healthcare Provider Details

I. General information

NPI: 1629037650
Provider Name (Legal Business Name): RHONDA L HEISE APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 N WESTFIELD RD
MADISON WI
53717-1038
US

IV. Provider business mailing address

1126 N WESTFIELD RD
MADISON WI
53717-1038
US

V. Phone/Fax

Practice location:
  • Phone: 608-827-8351
  • Fax:
Mailing address:
  • Phone: 608-827-8351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number113639
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1850
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: