Healthcare Provider Details

I. General information

NPI: 1831240936
Provider Name (Legal Business Name): HEATHER RAE ZUTZ APNP, GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 W RESEARCH DR
MILWAUKEE WI
53226-3452
US

IV. Provider business mailing address

1809 E OLIVE ST APT 301
SHOREWOOD WI
53211-2051
US

V. Phone/Fax

Practice location:
  • Phone: 414-708-1430
  • Fax:
Mailing address:
  • Phone: 414-708-1430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2588-033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: