Individual
MRS. JENIA R HEAVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
12 N 64TH ST, BELLEVILLE, IL 62223-3809
(618) 397-0900
Mailing address
205 CRYSTAL LN, FAIRVIEW HEIGHTS, IL 62208-2963
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
209012258
IL
363LF0000X
Family Nurse Practitioner
Primary
309.008084
IL
Other
Enumeration date
01/13/2015
Last updated
11/14/2019
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