Individual
JENNIFER N HEISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
25 N WINFIELD RD, WINFIELD, IL 60190
(630) 933-4487
Mailing address
25 N WINFIELD RD, WINFIELD, IL 60190-1295
(630) 933-4487
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209009502
IL
363LF0000X
Family Nurse Practitioner
209.009502
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CA4748
MEDICARE RAILROAD GROUP PTAN
IL
01
—
P10398553
MEDICARE RAILROAD
IL
Enumeration date
05/17/2012
Last updated
06/22/2018
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