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Individual

MISS HEATHER MARITA NICCOLI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
HS3

Contact information

Practice address
2420 S LINCOLN MEMORIAL DR, USCG SECTOR LAKE MICHIGAN-MEDICAL, MILWAUKEE, WI 53207-1902
(414) 747-7110
(414) 747-7891
Mailing address
3431 S 113TH ST APT 3, WEST ALLIS, WI 53227-3954
(414) 747-7110
(414) 747-7891

Taxonomy

Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
1259829
CA

Other

Enumeration date
10/03/2006
Last updated
07/08/2007
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