Provider Demographics
NPI:1306864806
Name:HENDERSON, HEATHER L (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:L
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-3951
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:3351 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-1004
Practice Address - Country:US
Practice Address - Phone:800-323-8622
Practice Address - Fax:224-225-0350
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP329599363LP2300X
IL209006743363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250792700Medicaid
IL215434022Medicare PIN
FLQ52963Medicare UPIN
FLU60752Medicare ID - Type UnspecifiedMEDICARE
IL215435022Medicare PIN