Provider Demographics
NPI:1326939208
Name:THEISEN, HEATHER KRISTINE
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:KRISTINE
Last Name:THEISEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84131 562 AVE
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:NE
Mailing Address - Zip Code:68779-2103
Mailing Address - Country:US
Mailing Address - Phone:402-841-9088
Mailing Address - Fax:
Practice Address - Street 1:802 CUSTER AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-0859
Practice Address - Country:US
Practice Address - Phone:402-841-9088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant