Provider Demographics
NPI:1518408442
Name:HIETPAS, EMILY E (RN)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:E
Last Name:HIETPAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 WILLIAMSEN CT
Mailing Address - Street 2:
Mailing Address - City:LITTLE CHUTE
Mailing Address - State:WI
Mailing Address - Zip Code:54140-2259
Mailing Address - Country:US
Mailing Address - Phone:920-858-4765
Mailing Address - Fax:
Practice Address - Street 1:1300 WILLIAMSEN CT
Practice Address - Street 2:
Practice Address - City:LITTLE CHUTE
Practice Address - State:WI
Practice Address - Zip Code:54140-2259
Practice Address - Country:US
Practice Address - Phone:920-858-4765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-11
Last Update Date:2017-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI166451163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse