1801910047 NPI number — MS. HEIDI H. VANDERPOOL APNP, CPNP

Table of content: MS. HEIDI H. VANDERPOOL APNP, CPNP (NPI 1801910047)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801910047 NPI number — MS. HEIDI H. VANDERPOOL APNP, CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANDERPOOL
Provider First Name:
HEIDI
Provider Middle Name:
H.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APNP, CPNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VERTELKA
Provider Other First Name:
HEIDI
Provider Other Middle Name:
H.
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
APNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1801910047
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9000 W WISCONSIN AVE
Provider Second Line Business Mailing Address:
PEDIATRIC UROLOGY
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53226-4874
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-266-3794
Provider Business Mailing Address Fax Number:
414-266-1752

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9000 W WISCONSIN AVE
Provider Second Line Business Practice Location Address:
PEDIATRIC UROLOGY
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53226-4874
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-266-3794
Provider Business Practice Location Address Fax Number:
414-266-1752
Provider Enumeration Date:
03/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  141584 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1801910047 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20061223 . This is a "CPNP CERTIFICATION" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com