Provider Demographics
NPI:1750504916
Name:WEBER, HEATHER MARY (APNP)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:MARY
Last Name:WEBER
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:MARY
Other - Last Name:BLANKENHEIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:830 EAST RIVER DRIVE
Mailing Address - Street 2:APT F
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115
Mailing Address - Country:US
Mailing Address - Phone:920-336-4123
Mailing Address - Fax:
Practice Address - Street 1:622 BODART ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301
Practice Address - Country:US
Practice Address - Phone:920-437-9773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1172033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43871800Medicaid