Provider Demographics
NPI:1225686330
Name:BEVERS, HEATHER JEAN (DNP, APNP, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:JEAN
Last Name:BEVERS
Suffix:
Gender:F
Credentials:DNP, APNP, FNP-C
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:JEAN
Other - Last Name:HERMUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7226
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:1630 COMMANCHE AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-5753
Practice Address - Country:US
Practice Address - Phone:920-430-4585
Practice Address - Fax:920-430-4569
Is Sole Proprietor?:No
Enumeration Date:2019-09-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI194220-30163W00000X
WI9389-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
F06193049OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS