Provider Demographics
NPI:1154671071
Name:HEITMAN, ALISA KEARNEY (FNP)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:KEARNEY
Last Name:HEITMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ALISA
Other - Middle Name:COLLEEN
Other - Last Name:KEARNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:522 S CATHERINE AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2823
Mailing Address - Country:US
Mailing Address - Phone:206-271-0751
Mailing Address - Fax:
Practice Address - Street 1:5700 S MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637
Practice Address - Country:US
Practice Address - Phone:888-824-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018421363LF0000X
CA21250363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily