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General NPI Number Information
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NPI Number | 1730273038
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Entity Type | Individual
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Provider Name | HEATHER MARITA NICCOLI HS3
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Gender | Female
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2420 S LINCOLN MEMORIAL DR USCG SECTOR LAKE MICHIGAN-MEDICAL
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City | MILWAUKEE
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State | WI
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Zip | 53207-1902
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Country | US
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Telephone | 414-747-7110
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Fax | 414-747-7891
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Provider Business Mailing Address
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Address Line | 3431 S 113TH ST APT 3
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City | WEST ALLIS
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State | WI
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Zip | 53227-3954
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Country | US
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Telephone | 414-747-7110
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Fax | 414-747-7891
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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 | 1710I1003X
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Taxonomy Name | Independent Duty Medical Technicians
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License Number | 1259829
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License Number State | CA
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