Healthcare Provider Details

I. General information

NPI: 1851673933
Provider Name (Legal Business Name): HEATHER J OHNEMUS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER MCGONEGLE

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 04/30/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 11TH ST
DE WITT IA
52742-1210
US

IV. Provider business mailing address

1008 11TH ST
DE WITT IA
52742-1210
US

V. Phone/Fax

Practice location:
  • Phone: 563-659-9137
  • Fax: 563-659-9869
Mailing address:
  • Phone: 563-659-9137
  • Fax: 563-659-9869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209009064
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberH121913
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: