Healthcare Provider Details

I. General information

NPI: 1992966287
Provider Name (Legal Business Name): HEATHER LANE MCCOLLOUGH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 JOHN DEERE RD
MOLINE IL
61265-6892
US

IV. Provider business mailing address

500 JOHN DEERE RD
MOLINE IL
61265-6892
US

V. Phone/Fax

Practice location:
  • Phone: 309-779-4940
  • Fax:
Mailing address:
  • Phone: 309-779-4940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberIA A087090
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.005344
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: