Healthcare Provider Details

I. General information

NPI: 1477817138
Provider Name (Legal Business Name): MARGARET M HEFFERON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 03/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 N LAKE SHORE DR SUITE 830
CHICAGO IL
60611-4546
US

IV. Provider business mailing address

680 N LAKE SHORE DR SUITE 830
CHICAGO IL
60611-4546
US

V. Phone/Fax

Practice location:
  • Phone: 312-943-7850
  • Fax: 312-943-2955
Mailing address:
  • Phone: 312-943-7850
  • Fax: 312-943-2955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.009563
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.350457
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: