Provider Demographics
NPI:1104909407
Name:COUNTY OF RICHLAND
Entity type:Organization
Organization Name:COUNTY OF RICHLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:618-392-6241
Mailing Address - Street 1:501 S WHITTLE AVE
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-2264
Mailing Address - Country:US
Mailing Address - Phone:618-392-6241
Mailing Address - Fax:618-393-4078
Practice Address - Street 1:501 S WHITTLE AVE
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-2264
Practice Address - Country:US
Practice Address - Phone:618-392-6241
Practice Address - Fax:618-393-4078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-189529163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid