Provider Demographics
NPI:1639504277
Name:HEIMSCH, KRISTINA M (APNP)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:M
Last Name:HEIMSCH
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:M
Other - Last Name:BUB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP, FNP-BC
Mailing Address - Street 1:505 SWEETBRIAR LN
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53098-1207
Mailing Address - Country:US
Mailing Address - Phone:414-698-2210
Mailing Address - Fax:
Practice Address - Street 1:147 W ROCKWELL ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:WI
Practice Address - Zip Code:53549-2048
Practice Address - Country:US
Practice Address - Phone:920-674-6255
Practice Address - Fax:920-674-5288
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI170726-30163W00000X
WI11165-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse