Provider Demographics
NPI:1336683127
Name:MIESS-GLADDING, HEIDI (NNP-BC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:MIESS-GLADDING
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2187 COLLADAY POINT DR
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-3076
Mailing Address - Country:US
Mailing Address - Phone:608-334-1564
Mailing Address - Fax:
Practice Address - Street 1:700 S PARK ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1830
Practice Address - Country:US
Practice Address - Phone:608-258-6831
Practice Address - Fax:608-258-6340
Is Sole Proprietor?:No
Enumeration Date:2016-12-13
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI115754030163W00000X
WI621333363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No163W00000XNursing Service ProvidersRegistered Nurse