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General NPI Number Information
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NPI Number | 1992900468
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Entity Type | Individual
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Provider Name | HEATHER C NIXON M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/15/2007
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 1740 W TAYLOR ST
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City | CHICAGO
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State | IL
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Zip | 60612-7232
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Country | US
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Telephone | 312-996-4050
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Fax |
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Provider Business Mailing Address
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Address Line | 1455 N WASHTENAW AVE
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City | CHICAGO
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State | IL
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Zip | 60622-1683
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Country | US
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Telephone | 773-615-9419
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Fax |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 036125605
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 125-051756
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License Number State | IL
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