Provider Demographics
NPI:1396134599
Name:HEISER, DIANE L (LPN)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:L
Last Name:HEISER
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 1:521 BILLINGS AVE
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU SAC
Mailing Address - State:WI
Mailing Address - Zip Code:53578-2122
Mailing Address - Country:US
Mailing Address - Phone:608-963-9124
Mailing Address - Fax:
Practice Address - Street 1:521 BILLINGS AVE
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU SAC
Practice Address - State:WI
Practice Address - Zip Code:53578-2122
Practice Address - Country:US
Practice Address - Phone:608-963-9124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33294-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse