Individual
TAMMY ANN HEIDENTHAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4119 MILLER OAKS DR, MCHENRY, IL 60051-6252
(847) 989-2490
Mailing address
4119 MILLER OAKS DR, MCHENRY, IL 60051-6252
(847) 989-2490
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
41247545
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202327
4119
IL
Enumeration date
07/04/2022
Last updated
07/04/2022
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