Healthcare Provider Details

I. General information

NPI: 1396840351
Provider Name (Legal Business Name): ANN M HEISE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2251 N SHORE DR
RHINELANDER WI
54501-8360
US

IV. Provider business mailing address

2251 N SHORE DR
RHINELANDER WI
54501-8360
US

V. Phone/Fax

Practice location:
  • Phone: 715-361-2300
  • Fax: 715-361-2877
Mailing address:
  • Phone: 715-361-2300
  • Fax: 715-361-2877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: