Provider Demographics
NPI:1376192567
Name:HEART TO HEART PEDIATRICS LLC
Entity Type:Organization
Organization Name:HEART TO HEART PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:GINNY
Authorized Official - Middle Name:M
Authorized Official - Last Name:PETER
Authorized Official - Suffix:
Authorized Official - Credentials:CPNP
Authorized Official - Phone:618-939-0112
Mailing Address - Street 1:224 BRADFORD LN
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-3369
Mailing Address - Country:US
Mailing Address - Phone:618-939-0112
Mailing Address - Fax:
Practice Address - Street 1:224 BRADFORD LN
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-3369
Practice Address - Country:US
Practice Address - Phone:618-939-0112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-10
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty