Provider Demographics
NPI:1609118660
Name:ELDRIDGE, HEATHER L (CAC, MSOM)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:L
Last Name:ELDRIDGE
Suffix:
Gender:F
Credentials:CAC, MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3632 W LAKEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-4135
Mailing Address - Country:US
Mailing Address - Phone:414-630-7229
Mailing Address - Fax:
Practice Address - Street 1:3632 W LAKEFIELD DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4135
Practice Address - Country:US
Practice Address - Phone:414-630-7229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI786-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist