Provider Demographics
NPI:1750607750
Name:HEISEL, SHARON MARIE (RN)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:MARIE
Last Name:HEISEL
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 1:11888 COUNTY ZZ
Mailing Address - Street 2:
Mailing Address - City:POUND
Mailing Address - State:WI
Mailing Address - Zip Code:54161-8749
Mailing Address - Country:US
Mailing Address - Phone:920-897-3110
Mailing Address - Fax:
Practice Address - Street 1:11888 COUNTY ZZ
Practice Address - Street 2:
Practice Address - City:POUND
Practice Address - State:WI
Practice Address - Zip Code:54161-8749
Practice Address - Country:US
Practice Address - Phone:920-897-3110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60770-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse