Provider Demographics
NPI:1780932582
Name:GNADT, HEATHER (LPN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:GNADT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 CHIPPEWA DR
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-6908
Mailing Address - Country:US
Mailing Address - Phone:414-334-9812
Mailing Address - Fax:
Practice Address - Street 1:6580 S 46TH ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-8153
Practice Address - Country:US
Practice Address - Phone:414-421-0276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI315843-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse