Provider Demographics
NPI:1821482795
Name:FOCHESATO, HEATHER R (APNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:R
Last Name:FOCHESATO
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:R
Other - Last Name:RISNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:PO BOX 22040
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2040
Mailing Address - Country:US
Mailing Address - Phone:920-445-7222
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:2820 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-3834
Practice Address - Country:US
Practice Address - Phone:920-433-6073
Practice Address - Fax:715-735-5388
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9202-33363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
2019074038OtherAMERICAN NURSES CREDENTIALING CENTER
F0215315OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS