Provider Demographics
NPI:1174831150
Name:SAJDAK HETZEL, ALLISON R (APNP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:R
Last Name:SAJDAK HETZEL
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 GATEWAY CT
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-8539
Mailing Address - Country:US
Mailing Address - Phone:262-335-8600
Mailing Address - Fax:262-335-2100
Practice Address - Street 1:1100 GATEWAY CT
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-8539
Practice Address - Country:US
Practice Address - Phone:262-335-8600
Practice Address - Fax:262-335-2100
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4175363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK400284083Medicare PIN
WIK400284066Medicare PIN