=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093003147
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER LEIGH HEBERT RDMS, RVT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2011
-----------------------------------------------------
Last Update Date | 07/11/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 N STATE ROUTE 1 BUILDING 3, SUITE 1
-----------------------------------------------------
City | WATSEKA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60970-7562
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-432-0100
-----------------------------------------------------
Fax | 815-432-0900
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2404 N 2110 EAST RD
-----------------------------------------------------
City | WATSEKA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60970-6059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-432-2621
-----------------------------------------------------
Fax | 815-432-0900
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246XS1301X
-----------------------------------------------------
Taxonomy Name | Sonography Specialist/Technologist Cardiovascular
-----------------------------------------------------
License Number | 92627
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 247100000X
-----------------------------------------------------
Taxonomy Name | Radiologic Technologist
-----------------------------------------------------
License Number | 500484028
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------