Provider Demographics
NPI:1487902748
Name:FRIESS, HEATHER VICTORIA (RN)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:VICTORIA
Last Name:FRIESS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6336 W LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-1467
Mailing Address - Country:US
Mailing Address - Phone:414-915-3940
Mailing Address - Fax:
Practice Address - Street 1:1825 N PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-1933
Practice Address - Country:US
Practice Address - Phone:414-274-8442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI133046-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse