Provider Demographics
NPI:1972001758
Name:MICHALIDES, HEATHER (NP-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MICHALIDES
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 WATERVILLE LN
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-4511
Mailing Address - Country:US
Mailing Address - Phone:847-858-9824
Mailing Address - Fax:
Practice Address - Street 1:830 W END CT STE 400
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1344
Practice Address - Country:US
Practice Address - Phone:847-247-6910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-26
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.016774363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily