=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922932995
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER WARAX RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2026
-----------------------------------------------------
Last Update Date | 06/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 S ALMON ST
-----------------------------------------------------
City | BOWLER
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54416-9745
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-793-4101
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1216 S ANDREWS ST
-----------------------------------------------------
City | SHAWANO
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54166-3408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-471-6702
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WS0200X
-----------------------------------------------------
Taxonomy Name | School Registered Nurse
-----------------------------------------------------
License Number | 1100443-30
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------