Provider Demographics
NPI:1861223463
Name:WONDER, HEIDI ANN (CPNP-PC)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:ANN
Last Name:WONDER
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 S SMITH AVE
Mailing Address - Street 2:
Mailing Address - City:KENESAW
Mailing Address - State:NE
Mailing Address - Zip Code:68956-1503
Mailing Address - Country:US
Mailing Address - Phone:308-991-1351
Mailing Address - Fax:
Practice Address - Street 1:2116 W FAIDLEY AVE STE 2100
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4602
Practice Address - Country:US
Practice Address - Phone:308-382-4297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE115552363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty