Provider Demographics
NPI:1467415703
Name:HEISLEN, KAREN LEE (LPN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LEE
Last Name:HEISLEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W251N9296 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-1041
Mailing Address - Country:US
Mailing Address - Phone:262-628-9034
Mailing Address - Fax:
Practice Address - Street 1:W251N9296 CRESTWOOD DR
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089-1041
Practice Address - Country:US
Practice Address - Phone:262-628-9034
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18779/031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse