Provider Demographics
NPI:1740516541
Name:BECKSTROM, HEIDI J (APN)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:J
Last Name:BECKSTROM
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5777 DEPT
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-5777
Mailing Address - Country:US
Mailing Address - Phone:312-695-9797
Mailing Address - Fax:630-933-2740
Practice Address - Street 1:1850 GATEWAY DR STE 100
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3192
Practice Address - Country:US
Practice Address - Phone:815-217-3252
Practice Address - Fax:815-756-4941
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007813363LF0000X, 364SE0003X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SE0003XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistEmergency