Provider Demographics
NPI:1578938338
Name:LEE, HEATHER L (MSN, AGNP, OCN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:LEE
Suffix:
Gender:F
Credentials:MSN, AGNP, OCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2015-12-04
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-013470363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL355031OtherMEDICARE GROUP NUMBER
ILF400264776Medicare PIN