Provider Demographics
NPI:1245411669
Name:REQUET, HEATHER KOCINSKI (WHNP, CNM)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:KOCINSKI
Last Name:REQUET
Suffix:
Gender:
Credentials:WHNP, CNM
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:DAWN
Other - Last Name:KOCINSKI WILDEBRANDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1118 HAMPSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-3027
Mailing Address - Country:US
Mailing Address - Phone:217-222-6550
Mailing Address - Fax:
Practice Address - Street 1:1118 HAMPSHIRE ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-3027
Practice Address - Country:US
Practice Address - Phone:172-226-5502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209032273367A00000X
MO2002025778364SW0102X
MO2015023430367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health