Healthcare Provider Details

I. General information

NPI: 1346236783
Provider Name (Legal Business Name): AUDREY KATHERINE HEBERT RN, MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: AUDREY KATHERINE VARGA RN

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 N 9TH ST
MILWAUKEE WI
53233-1411
US

IV. Provider business mailing address

6015 S ABERDEEN DR
NEW BERLIN WI
53146-5204
US

V. Phone/Fax

Practice location:
  • Phone: 414-765-0606
  • Fax: 414-765-0226
Mailing address:
  • Phone: 262-679-1984
  • Fax: 414-765-0226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN 63583-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: