Provider Demographics
NPI:1306195649
Name:HEINDL, ANNA MARIA (LPN)
Entity type:Individual
Prefix:MS
First Name:ANNA
Middle Name:MARIA
Last Name:HEINDL
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 1:1614 VICTORIA DR
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-7413
Mailing Address - Country:US
Mailing Address - Phone:262-894-8065
Mailing Address - Fax:
Practice Address - Street 1:13105 WATERTOWN PLANK RD
Practice Address - Street 2:
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2213
Practice Address - Country:US
Practice Address - Phone:262-754-4481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31136031164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse