Provider Demographics
NPI:1306593918
Name:OLEJNICHAK, HEATHER ANN (FNP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:OLEJNICHAK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N4786 PINE LN
Mailing Address - Street 2:
Mailing Address - City:GILMAN
Mailing Address - State:WI
Mailing Address - Zip Code:54433-9210
Mailing Address - Country:US
Mailing Address - Phone:715-450-4341
Mailing Address - Fax:
Practice Address - Street 1:6 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:OWEN
Practice Address - State:WI
Practice Address - Zip Code:54460-9534
Practice Address - Country:US
Practice Address - Phone:715-229-2177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11782-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty