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General NPI Number Information
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NPI Number | 1912266701
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Entity Type | Individual
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Provider Name | EMMA IREAN HEENAN RN
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Gender | Female
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Dates
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Enumeration Date | 05/14/2012
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Last Update Date | 03/07/2018
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Provider Practice Location Address
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Address Line | W4762 GOLF COURSE DR
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City | FOND DU LAC
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State | WI
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Zip | 54935-9016
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Country | US
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Telephone | 920-251-6541
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Fax |
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Provider Business Mailing Address
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Address Line | W4762 GOLF COURSE DR
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City | FOND DU LAC
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State | WI
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Zip | 54935-9016
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Country | US
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Telephone |
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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 | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 312094-31
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | 238955-30
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License Number State | WI
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