Provider Demographics
NPI:1063818094
Name:HECKENKAMP, MADELEINE D (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:D
Last Name:HECKENKAMP
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:MADELEINE
Other - Middle Name:D
Other - Last Name:O'DONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:PO BOX 3428
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62708-3428
Mailing Address - Country:US
Mailing Address - Phone:800-577-5368
Mailing Address - Fax:217-757-2021
Practice Address - Street 1:3132 OLD JACKSONVILLE RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-7400
Practice Address - Country:US
Practice Address - Phone:217-588-2600
Practice Address - Fax:217-862-0904
Is Sole Proprietor?:No
Enumeration Date:2014-11-19
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012212363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209012212OtherAPN LICENSE