Healthcare Provider Details

I. General information

NPI: 1295967511
Provider Name (Legal Business Name): KIM ANN HEIM APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 E NEWPORT AVE SUITE 409
MILWAUKEE WI
53211-2984
US

IV. Provider business mailing address

6660 N ELM TREE RD
GLENDALE WI
53217-4045
US

V. Phone/Fax

Practice location:
  • Phone: 414-259-3900
  • Fax:
Mailing address:
  • Phone: 414-259-3900
  • Fax: 414-963-0000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number84192030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: