Healthcare Provider Details

I. General information

NPI: 1245411669
Provider Name (Legal Business Name): HEATHER KOCINSKI REQUET WHNP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER DAWN KOCINSKI WILDEBRANDT

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 HAMPSHIRE ST
QUINCY IL
62301-3027
US

IV. Provider business mailing address

1118 HAMPSHIRE ST
QUINCY IL
62301-3027
US

V. Phone/Fax

Practice location:
  • Phone: 172-226-5502
  • Fax:
Mailing address:
  • Phone: 217-222-6550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209032273
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: