Individual
MAURISSA HEATON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1745 W WALNUT ST, JACKSONVILLE, IL 62650-6126
(217) 243-6454
Mailing address
1745 W WALNUT ST, JACKSONVILLE, IL 62650-6126
(217) 243-6454
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209027080
IL
Other
Enumeration date
04/27/2023
Last updated
06/09/2023
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