Healthcare Provider Details

I. General information

NPI: 1467415703
Provider Name (Legal Business Name): KAREN LEE HEISLEN LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W251N9296 CRESTWOOD DR
SUSSEX WI
53089-1041
US

IV. Provider business mailing address

W251N9296 CRESTWOOD DR
SUSSEX WI
53089-1041
US

V. Phone/Fax

Practice location:
  • Phone: 262-628-9034
  • Fax:
Mailing address:
  • Phone: 262-628-9034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number18779/031
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: