Provider Demographics
NPI:1639455793
Name:HETFIELD, CAROLINE F (ANP-BC)
Entity Type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:F
Last Name:HETFIELD
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:MS
Other - First Name:CAROLINE
Other - Middle Name:F
Other - Last Name:BERGLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP-BC
Mailing Address - Street 1:1510 TURNBERRY CT
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-3174
Mailing Address - Country:US
Mailing Address - Phone:630-302-1214
Mailing Address - Fax:
Practice Address - Street 1:2615 HARRISON ST
Practice Address - Street 2:
Practice Address - City:BELLWOOD
Practice Address - State:IL
Practice Address - Zip Code:60104-2450
Practice Address - Country:US
Practice Address - Phone:630-840-3232
Practice Address - Fax:630-840-3053
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.009078363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health