Healthcare Provider Details

I. General information

NPI: 1861879462
Provider Name (Legal Business Name): HEATHER JEAN GREILING APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2015
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N2930 STATE ROAD 22
WAUTOMA WI
54982-5267
US

IV. Provider business mailing address

3 NEENAH CTR
NEENAH WI
54956-3070
US

V. Phone/Fax

Practice location:
  • Phone: 920-787-4613
  • Fax:
Mailing address:
  • Phone: 920-830-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6343
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6343-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: