Healthcare Provider Details

I. General information

NPI: 1659709434
Provider Name (Legal Business Name): MICHELLE HEYLAND APN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2013
Last Update Date: 10/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8324 SKOKIE BLVD
SKOKIE IL
60077-2545
US

IV. Provider business mailing address

8324 SKOKIE BLVD
SKOKIE IL
60077-2545
US

V. Phone/Fax

Practice location:
  • Phone: 847-933-0051
  • Fax: 847-933-0057
Mailing address:
  • Phone: 847-933-0051
  • Fax: 847-933-0057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209010790
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: