Provider Demographics
NPI:1023433554
Name:HEUSER, LORI A (BSN RN)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:HEUSER
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ABBEY SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:WI
Mailing Address - Zip Code:53125-1822
Mailing Address - Country:US
Mailing Address - Phone:224-622-5866
Mailing Address - Fax:
Practice Address - Street 1:200 ABBEY SPRINGS DR
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:WI
Practice Address - Zip Code:53125-1822
Practice Address - Country:US
Practice Address - Phone:224-622-5866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI199468-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse