Healthcare Provider Details

I. General information

NPI: 1427285626
Provider Name (Legal Business Name): LISA HECK APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7725 N KNOXVILLE AVE
PEORIA IL
61614-2079
US

IV. Provider business mailing address

7725 N KNOXVILLE AVE
PEORIA IL
61614-2079
US

V. Phone/Fax

Practice location:
  • Phone: 309-495-0240
  • Fax:
Mailing address:
  • Phone: 309-495-0240
  • Fax: 309-689-9035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209007836
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number209-007836
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number041218246
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: