Provider Demographics
NPI:1023200268
Name:HEGLAND, STEPHANIE ELIZABETH (RN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ELIZABETH
Last Name:HEGLAND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 194
Mailing Address - Street 2:
Mailing Address - City:LONE ROCK
Mailing Address - State:WI
Mailing Address - Zip Code:53556-0194
Mailing Address - Country:US
Mailing Address - Phone:608-574-1608
Mailing Address - Fax:
Practice Address - Street 1:1550 WILDWOOD DR
Practice Address - Street 2:
Practice Address - City:PLAIN
Practice Address - State:WI
Practice Address - Zip Code:53577-9644
Practice Address - Country:US
Practice Address - Phone:608-574-9834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15356-030163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health