Healthcare Provider Details

I. General information

NPI: 1225642655
Provider Name (Legal Business Name): JESSICA FAITH HEPPNER CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7106 W NORTH AVE
WAUWATOSA WI
53213-1811
US

IV. Provider business mailing address

3430 N 88TH ST
MILWAUKEE WI
53222-3649
US

V. Phone/Fax

Practice location:
  • Phone: 262-432-3142
  • Fax: 262-203-5239
Mailing address:
  • Phone: 970-381-9633
  • Fax: 262-203-5239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number291-49
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: