Individual provider Active NPI

Heather M Wulterkens, AU.D.

  • Audiologist
  • Kenosha, WI
National Provider Identifier
1104858349
Registry record updated Nov 29, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
479 Issued in WI
Practice address
6308 8TH Ave
Suite 3000
Kenosha, WI 53143-5031
Phone
(262) 656-3300
NPI assigned
Jul 7, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 479 WI Primary

Addresses

Primary practice location

6308 8TH Ave
Suite 3000
Kenosha, WI 53143-5031

Mailing address

6308 8TH Ave
Suite 3000
Kenosha, WI 53143-5031
Phone (262) 656-3300

Other identifiers 1

IdentifierTypeStateIssuer
41151100MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
479WIMDCardiovascular Disease Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196294400000",
    "number": "1104858349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6308 8TH AVE",
            "address_2": "SUITE 3000",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531435031",
            "telephone_number": "262-656-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6308 8TH AVE",
            "address_2": "SUITE 3000",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531435031",
            "telephone_number": "262-656-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WULTERKENS",
        "first_name": "HEATHER",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "AU.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-07",
        "last_updated": "2007-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "WI",
            "license": "479",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41151100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenosha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.