Provider Demographics
NPI:1508919390
Name:HECKER, JULIE JEAN (LPN RCS)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:JEAN
Last Name:HECKER
Suffix:
Gender:F
Credentials:LPN RCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W814 ARROWHEAD ROAD
Mailing Address - Street 2:
Mailing Address - City:MONTELLO
Mailing Address - State:WI
Mailing Address - Zip Code:53949-7943
Mailing Address - Country:US
Mailing Address - Phone:608-712-1359
Mailing Address - Fax:
Practice Address - Street 1:W814 ARROWHEAD ROAD
Practice Address - Street 2:
Practice Address - City:MONTELLO
Practice Address - State:WI
Practice Address - Zip Code:53949-7943
Practice Address - Country:US
Practice Address - Phone:608-712-1359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38270500Medicaid