Provider Demographics
NPI:1841575313
Name:HECK, CATHLEEN A (RN)
Entity type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:A
Last Name:HECK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2077 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:NORTH PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-7833
Mailing Address - Country:US
Mailing Address - Phone:309-382-2006
Mailing Address - Fax:309-382-2007
Practice Address - Street 1:2077 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:NORTH PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-7833
Practice Address - Country:US
Practice Address - Phone:309-382-2006
Practice Address - Fax:309-382-2007
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041377343163W00000X, 163WP0808X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult