Individual
EDITH ANN HEADRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
7525 ENGLISH LAKE ROAD, MANITOWOC, WI 54220
(920) 758-3410
Mailing address
7525 ENGLISH LAKE ROAD, MANITOWOC, WI 54220
(920) 758-3410
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
Primary
78218-030
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35024500
—
WI
Enumeration date
06/21/2007
Last updated
07/09/2007
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