Individual
LISA HECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
7725 N KNOXVILLE AVE, PEORIA, IL 61614-2079
(309) 495-0240
Mailing address
7725 N KNOXVILLE AVE, PEORIA, IL 61614-2079
(309) 495-0240
(309) 689-9035
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
041218246
IL
363L00000X
Nurse Practitioner
Primary
209007836
IL
364S00000X
Clinical Nurse Specialist
209-007836
IL
Other
Enumeration date
06/15/2009
Last updated
01/10/2022
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