Healthcare Provider Details

I. General information

NPI: 1306864806
Provider Name (Legal Business Name): HEATHER L HENDERSON APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3351 W MAIN ST
ST CHARLES IL
60175-1004
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-3951
US

V. Phone/Fax

Practice location:
  • Phone: 800-323-8622
  • Fax: 224-225-0350
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number277000399
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberARNP329599
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209006743
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: