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General NPI Number Information
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NPI Number | 1700430949
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Entity Type | Individual
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Provider Name | HEIDI ELIZABETH BESCH
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Gender | Female
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Dates
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Enumeration Date | 07/26/2019
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Last Update Date | 07/26/2019
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Provider Practice Location Address
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Address Line | 525 WALLACE ST
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City | NEW LONDON
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State | WI
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Zip | 54961-2165
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Country | US
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Telephone | 715-281-0782
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Fax |
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Provider Business Mailing Address
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Address Line | 359 OAK ST
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City | MENASHA
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State | WI
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Zip | 54952-3335
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Country | US
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Telephone | 920-851-0838
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 324091
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License Number State | WI
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