Provider Demographics
NPI:1649419219
Name:HUNEMULLER, HEATHER L (ARNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:HUNEMULLER
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 1:1228 E RUSHOLME ST STE 3060
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-2453
Mailing Address - Country:US
Mailing Address - Phone:563-421-4244
Mailing Address - Fax:563-421-4249
Practice Address - Street 1:1228 E RUSHOLME ST STE 3060
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2453
Practice Address - Country:US
Practice Address - Phone:563-421-4244
Practice Address - Fax:563-421-4249
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007438363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA112392OtherLICENSE
IL209007436OtherLICENSE