Provider Demographics
NPI:1205516093
Name:HEUGEL, ALICIA
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:HEUGEL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 SEMINOLE DR
Mailing Address - Street 2:
Mailing Address - City:KANSASVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53139-9749
Mailing Address - Country:US
Mailing Address - Phone:217-552-2738
Mailing Address - Fax:
Practice Address - Street 1:5000 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53295-0001
Practice Address - Country:US
Practice Address - Phone:414-384-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PANPPA067811363LP0808X
WI1419233363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty