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General NPI Number Information
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NPI Number | 1134999147
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Entity Type | Individual
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Provider Name | JILL MARIE HEITZIG
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Gender | Female
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Dates
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Enumeration Date | 01/02/2024
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 1 HAIRPIN DRIVE
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City | EDWARDSVILLE
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State | IL
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Zip | 62026-0001
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Country | US
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Telephone | 618-650-3956
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Fax |
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Provider Business Mailing Address
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Address Line | 6702 GODFREY RD
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City | GODFREY
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State | IL
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Zip | 62035-2205
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Country | US
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Telephone | 618-467-1520
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Fax | 618-467-1521
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209033216
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License Number State | IL
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