Provider Demographics
NPI:1548439029
Name:MACHEL, HEATHER RAE (RN)
Entity type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:RAE
Last Name:MACHEL
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 1:7922 RAINBOW RD
Mailing Address - Street 2:
Mailing Address - City:LAKE TOMAHAWK
Mailing Address - State:WI
Mailing Address - Zip Code:54539-9531
Mailing Address - Country:US
Mailing Address - Phone:715-892-7854
Mailing Address - Fax:
Practice Address - Street 1:7922 RAINBOW RD
Practice Address - Street 2:
Practice Address - City:LAKE TOMAHAWK
Practice Address - State:WI
Practice Address - Zip Code:54539-9531
Practice Address - Country:US
Practice Address - Phone:715-892-7854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35051600Medicaid