Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 5162 | MN |
N | 363L00000X | Nurse Practitioner | 5683 | WI |
N | 363LN0000X | Nurse Practitioner - Neonatal | 5162 | MN |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 5683 | WI |
NPI | 1043634496 |
---|---|
Provider Name | Theresa J Heise |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2014 |
Last Update Date | 27/10/2020 |