Healthcare Provider Details

I. General information

NPI: 1063818094
Provider Name (Legal Business Name): MADELEINE D HECKENKAMP APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADELEINE D O'DONNELL APN

II. Dates (important events)

Enumeration Date: 11/19/2014
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E CARPENTER ST
SPRINGFIELD IL
62702-5104
US

IV. Provider business mailing address

PO BOX 19248
SPRINGFIELD IL
62794-9248
US

V. Phone/Fax

Practice location:
  • Phone: 217-528-7541
  • Fax:
Mailing address:
  • Phone: 217-528-7541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209012212
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: