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NPI Code Detail

MEDICARE: CELIA A HETHKE RNC, ANP, APN

MEDICARE: CELIA A HETHKE RNC, ANP, APN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2200XAdult Health Nurse Practitioner041-171180IL
2363LA2200XAdult Health Nurse Practitioner209-001278(41-17118)IL

General Provider Information

NPI Number : 1104922236
Entity Type Code : Individual
Provider Name (Legal Business Name) : CELIA A HETHKE RNC, ANP, APN
Provider Business Mailing Address
First Line : 112 KENDALL ST
Second Line :
City : GIFFORD
State : IL
Zip : 61847-9602
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 227 N MARKET ST
Second Line :
City : PAXTON
State : IL
Zip : 60957-1123
Country : US
Telephone Number : 217-379-4864
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2006
Last Update Date : 05/22/2012

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