Provider Demographics
NPI:1043981285
Name:DUARTE, HEATHER LYN
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:LYN
Last Name:DUARTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 SW CROSS ST
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:62353-1445
Mailing Address - Country:US
Mailing Address - Phone:608-369-2252
Mailing Address - Fax:
Practice Address - Street 1:2200 LAKE VICTORIA DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-5596
Practice Address - Country:US
Practice Address - Phone:312-913-2361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.024078363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health