Provider Demographics
NPI:1710027313
Name:WIERTZEMA, HALLIE ELIZABETH (RN)
Entity Type:Individual
Prefix:MRS
First Name:HALLIE
Middle Name:ELIZABETH
Last Name:WIERTZEMA
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 1:460 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND CENTER
Mailing Address - State:WI
Mailing Address - Zip Code:53581-1833
Mailing Address - Country:US
Mailing Address - Phone:608-649-2705
Mailing Address - Fax:
Practice Address - Street 1:460 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581-1833
Practice Address - Country:US
Practice Address - Phone:608-649-2705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38267700Medicaid