Provider Demographics
NPI:1568836070
Name:ILLINOIS CANCER SPECIALISTS
Entity Type:Organization
Organization Name:ILLINOIS CANCER SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, AGNP, OCN
Authorized Official - Phone:847-259-4482
Mailing Address - Street 1:880 W CENTRAL RD
Mailing Address - Street 2:SUITE 8200
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2355
Mailing Address - Country:US
Mailing Address - Phone:847-259-4482
Mailing Address - Fax:847-259-6406
Practice Address - Street 1:880 W CENTRAL RD
Practice Address - Street 2:SUITE 8200
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2355
Practice Address - Country:US
Practice Address - Phone:847-259-4482
Practice Address - Fax:847-259-6406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-013470363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty