Provider Demographics
NPI:1336994011
Name:HARTY, HEATHER M (RN, BSN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:HARTY
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:M
Other - Last Name:LUCEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:314 S MONROE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:WI
Mailing Address - Zip Code:53813-2049
Mailing Address - Country:US
Mailing Address - Phone:608-732-7930
Mailing Address - Fax:
Practice Address - Street 1:9380 ORFIELD LN
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:WI
Practice Address - Zip Code:53813-9532
Practice Address - Country:US
Practice Address - Phone:608-723-2301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI243515163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse