Healthcare Provider Details

I. General information

NPI: 1073438693
Provider Name (Legal Business Name): HEATHER GEAREN FNP LICENSE PENDING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2455 DEAN ST UNIT D
ST CHARLES IL
60175-4830
US

IV. Provider business mailing address

2455 DEAN ST UNIT D
ST CHARLES IL
60175-4830
US

V. Phone/Fax

Practice location:
  • Phone: 847-905-0001
  • Fax:
Mailing address:
  • Phone: 847-905-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209036411
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number041327615
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: