Healthcare Provider Details

I. General information

NPI: 1104922236
Provider Name (Legal Business Name): CELIA A HETHKE RNC, ANP, APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 N MARKET ST
PAXTON IL
60957-1123
US

IV. Provider business mailing address

112 KENDALL ST
GIFFORD IL
61847-9602
US

V. Phone/Fax

Practice location:
  • Phone: 217-379-4864
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number041-171180
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209-001278(41-17118)
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: