Provider Demographics
NPI:1932498672
Name:MARENDIUK, HEIDI NOELLE (CRNA)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:NOELLE
Last Name:MARENDIUK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:NOELLE
Other - Last Name:HERNDIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:430 E DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-4560
Mailing Address - Country:US
Mailing Address - Phone:920-926-4920
Mailing Address - Fax:920-926-4875
Practice Address - Street 1:430 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-4560
Practice Address - Country:US
Practice Address - Phone:920-926-4920
Practice Address - Fax:920-926-4875
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACRNA086652367500000X
WI1101135367500000X
WI13299-33367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered