Provider Demographics
NPI:1114558632
Name:HEILENBACH, ALLISON (APN)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:HEILENBACH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 N ELM ST STE 210
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3637
Mailing Address - Country:US
Mailing Address - Phone:630-856-8640
Mailing Address - Fax:
Practice Address - Street 1:908 N ELM ST STE 210
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3637
Practice Address - Country:US
Practice Address - Phone:630-856-8640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020442363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily