Provider Demographics
NPI:1013281369
Name:RECKLIES, HEATHER JANE (RN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:JANE
Last Name:RECKLIES
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 1:120 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:WI
Mailing Address - Zip Code:53121-1618
Mailing Address - Country:US
Mailing Address - Phone:262-723-3042
Mailing Address - Fax:
Practice Address - Street 1:120 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121-1618
Practice Address - Country:US
Practice Address - Phone:262-723-3042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI159657-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse