Provider Demographics
NPI:1285886531
Name:WARMBOLD, HEIDI K (NP)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:K
Last Name:WARMBOLD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5703 MEMORIAL CT
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476-6502
Mailing Address - Country:US
Mailing Address - Phone:843-476-1684
Mailing Address - Fax:
Practice Address - Street 1:ASPIRUS MERRILL HOSPITAL
Practice Address - Street 2:601 S CENTER AVE
Practice Address - City:MERRILL
Practice Address - State:WI
Practice Address - Zip Code:54452
Practice Address - Country:US
Practice Address - Phone:843-476-1684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10947-33363LP0808X
NDR33773363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty