Healthcare Provider Details

I. General information

NPI: 1992014310
Provider Name (Legal Business Name): JUDY ANN HEIL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 10/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5268 LONG DR
STRATFORD WI
54484-9491
US

IV. Provider business mailing address

5268 LONG DRIVE
STRATFORD WI
54484
US

V. Phone/Fax

Practice location:
  • Phone: 715-687-3451
  • Fax:
Mailing address:
  • Phone: 715-687-3451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number109540-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: