Provider Demographics
NPI:1588918494
Name:HETCHLER, VANESSA LEA (LPN)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:LEA
Last Name:HETCHLER
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 1:1422 PLAINFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53403-3616
Mailing Address - Country:US
Mailing Address - Phone:262-721-7710
Mailing Address - Fax:
Practice Address - Street 1:1422 PLAINFIELD AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53403-3616
Practice Address - Country:US
Practice Address - Phone:262-721-7710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI315387-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse