Healthcare Provider Details

I. General information

NPI: 1457504896
Provider Name (Legal Business Name): HEATHER K VARTANIAN APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER K SEUBERT

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13133 N PORT WASHINGTON RD STE 204
MEQUON WI
53097-2420
US

IV. Provider business mailing address

788 N JEFFERSON ST STE 300
MILWAUKEE WI
53202-3710
US

V. Phone/Fax

Practice location:
  • Phone: 262-243-2524
  • Fax: 262-243-2525
Mailing address:
  • Phone: 414-272-8950
  • Fax: 414-274-6250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number3548-033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: