Healthcare Provider Details

I. General information

NPI: 1962760041
Provider Name (Legal Business Name): HEATHER MARIE BECKERT APN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 04/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 FRANCISCAN DR
LITCHFIELD IL
62056-1778
US

IV. Provider business mailing address

1285 FRANCISCAN DR
LITCHFIELD IL
62056-1778
US

V. Phone/Fax

Practice location:
  • Phone: 217-324-1035
  • Fax: 217-324-5959
Mailing address:
  • Phone: 217-324-1035
  • Fax: 217-324-5959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209009473
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: