Provider Demographics
NPI:1669992004
Name:CAPODARCO, HEIDI (APNP)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:CAPODARCO
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6308 8TH AVENUE
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:KENOSAH
Mailing Address - State:WI
Mailing Address - Zip Code:53143-5031
Mailing Address - Country:US
Mailing Address - Phone:262-656-3313
Mailing Address - Fax:262-653-5850
Practice Address - Street 1:9555 76TH ST
Practice Address - Street 2:
Practice Address - City:PLEASANT PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53158-1984
Practice Address - Country:US
Practice Address - Phone:262-656-3313
Practice Address - Fax:262-653-5850
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI131503163WE0003X
WI7864-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WE0003XNursing Service ProvidersRegistered NurseEmergency