Matthew Anthony Hettenbach
Nurse Practitioner - Psychiatric/Mental Health
1244 Wisconsin Ave
Racine
, Wisconsin 53403-1987
Matthew Anthony Hettenbach
Nurse Practitioner - Psychiatric/Mental Health
1244 Wisconsin Ave
Racine
, Wisconsin 53403-1987
(262) 995-4662
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About
Features
Specialties
- Nurse Practitioner - Psychiatric/Mental Health
Languages spoken
- English
Location
First Address
- Matthew Anthony Hettenbach
- 2019 Saint Clair St
- Racine, WI
- Zip : 53402-4763
- Phone : (262) 995-4662
Second Address
- Matthew Anthony Hettenbach
- 1244 Wisconsin Ave
- Racine, WI
- Zip : 53403-1987
- Phone : (262) 687-2956
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 10089 | WI |
National Provider Identifier
| NPI | 1003430729 |
|---|---|
| Provider Name | Matthew Anthony Hettenbach |
| First Address | Racine, WI 53402-4763 |
| Second Address | Racine, WI 53403-1987 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 29/05/2020 |
| Last Update Date | 29/05/2020 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.