Healthcare Provider Details

I. General information

NPI: 1558712711
Provider Name (Legal Business Name): HEATHER MARIE RUNDE HILSABECK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 N 36TH ST
SAINT JOSEPH MO
64506-2977
US

IV. Provider business mailing address

711 N 36TH ST
SAINT JOSEPH MO
64506-2977
US

V. Phone/Fax

Practice location:
  • Phone: 816-271-4022
  • Fax: 816-271-4020
Mailing address:
  • Phone: 816-271-4022
  • Fax: 816-271-4020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2011003776
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2016022818
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: