Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 11169 | WI |
NPI | 1003584145 |
---|---|
Provider Name | Ann M Hefter |
First Address | Kaukauna, WI 54130-8223 |
Second Address | Appleton, WI 54915-1305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2021 |
Last Update Date | 14/10/2021 |