MEDICARE: MRS. HEATHER M HITESMAN ARNP

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
1	363LA2100X	Acute Care Nurse Practitioner	H120536	IA

General Provider Information

NPI Number	:	1992259642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEATHER M HITESMAN ARNP

Provider Business Mailing Address
First Line	:	PO BOX 4028
Second Line	:
City	:	ROCK ISLAND
State	:	IL
Zip	:	61204-4028
Country	:	US
Telephone Number	:	563-355-9200
Fax Number	:	563-355-3419

Provider Business Practice Location Address
First Line	:	1351 W. CENTRAL PARK
Second Line	:	SUITE 3300
City	:	DAVENPORT
State	:	IA
Zip	:	52804-1889
Country	:	US
Telephone Number	:	563-421-0430
Fax Number	:	563-421-0439

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2016
Last Update Date	:	04/15/2021

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