Provider Demographics
NPI:1356095301
Name:HEISLER, REBECCA (RD)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:HEISLER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3017
Mailing Address - Country:US
Mailing Address - Phone:319-521-4949
Mailing Address - Fax:
Practice Address - Street 1:701 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3017
Practice Address - Country:US
Practice Address - Phone:319-521-4949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered