Provider Demographics
NPI:1922244045
Name:KNOWLES, HEATHER DIANN (APN-BC ACNP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:DIANN
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:APN-BC ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4106 S WATER TOWER PL
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-6544
Mailing Address - Country:US
Mailing Address - Phone:618-242-8900
Mailing Address - Fax:618-242-8967
Practice Address - Street 1:4106 S WATER TOWER PL
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-6544
Practice Address - Country:US
Practice Address - Phone:618-242-8900
Practice Address - Fax:618-242-8967
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007400363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care