Provider Demographics
NPI:1336578582
Name:HEYDORN, PAMELA
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:HEYDORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 E BRUSH HILL RD
Mailing Address - Street 2:STE. 202
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5659
Mailing Address - Country:US
Mailing Address - Phone:630-782-4050
Mailing Address - Fax:630-782-5021
Practice Address - Street 1:133 E BRUSH HILL RD
Practice Address - Street 2:STE. 202
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5659
Practice Address - Country:US
Practice Address - Phone:630-782-4050
Practice Address - Fax:630-782-5021
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209006094364SC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCritical Care Medicine