Individual
HEIDI MARIE BRUCKERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1300 E GREEN BAY ST, SHAWANO, WI 54166-2210
(715) 201-0870
Mailing address
1300 E GREEN BAY ST, SHAWANO, WI 54166-2210
(920) 496-4700
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
126356-30
WI
363L00000X
Nurse Practitioner
Primary
8675-33
WI
Other
Enumeration date
05/30/2018
Last updated
09/13/2018
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