Provider Demographics
NPI:1801910047
Name:VANDERPOOL, HEIDI H (APNP, CPNP)
Entity type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:H
Last Name:VANDERPOOL
Suffix:
Gender:F
Credentials:APNP, CPNP
Other - Prefix:MS
Other - First Name:HEIDI
Other - Middle Name:H
Other - Last Name:VERTELKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:PEDIATRIC UROLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-3794
Mailing Address - Fax:414-266-1752
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:PEDIATRIC UROLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-3794
Practice Address - Fax:414-266-1752
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI141584363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1801910047Medicaid
20061223OtherCPNP CERTIFICATION
WI73601 2095Medicare PIN
20061223OtherCPNP CERTIFICATION