Healthcare Provider Details

I. General information

NPI: 1669105060
Provider Name (Legal Business Name): DANA HEINRICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANA MARKECH

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 COUNTY LINE RD
ALGONQUIN IL
60102-2566
US

IV. Provider business mailing address

6005 SANDERS CT
CARPENTERSVILLE IL
60110-3252
US

V. Phone/Fax

Practice location:
  • Phone: 708-853-3883
  • Fax:
Mailing address:
  • Phone: 224-622-7042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.025421
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: