Healthcare Provider Details

I. General information

NPI: 1790096642
Provider Name (Legal Business Name): HEIDI PAPENFUS WALASKI APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UW DEPT OF MEDICINE 600 HIGHLAND AVE
MADISON WI
53792-0001
US

IV. Provider business mailing address

UW DEPT OF MEDICINE 600 HIGHLAND AVE
MADISON WI
53792-0001
US

V. Phone/Fax

Practice location:
  • Phone: 608-256-1901
  • Fax: 608-280-7165
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1098
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number104155
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: