Provider Demographics
NPI:1447820204
Name:HEIMAN, TRACY LYNN (DNP, NNP-BC)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:LYNN
Last Name:HEIMAN
Suffix:
Gender:F
Credentials:DNP, NNP-BC
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:LYNN
Other - Last Name:MUELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, NNP-BC
Mailing Address - Street 1:N1076 VANDER MAAZEN DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54942-8749
Mailing Address - Country:US
Mailing Address - Phone:920-915-2259
Mailing Address - Fax:
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-6820
Practice Address - Fax:414-266-6979
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11276363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1447820204Medicaid