Provider Demographics
NPI:1043486681
Name:VANDE HEI, PATRICIA L (RN)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:L
Last Name:VANDE HEI
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:N6180 RIVERVIEW RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:WI
Mailing Address - Zip Code:53073-3502
Mailing Address - Country:US
Mailing Address - Phone:920-207-4764
Mailing Address - Fax:
Practice Address - Street 1:N6180 RIVERVIEW RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:WI
Practice Address - Zip Code:53073-3502
Practice Address - Country:US
Practice Address - Phone:920-207-4764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-04
Last Update Date:2008-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI56939163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39814200Medicaid