Provider Demographics
NPI:1124473046
Name:FIELDS, HEIDI (APN, NP-C)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:FIELDS
Suffix:
Gender:F
Credentials:APN, NP-C
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:A
Other - Last Name:HOVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 TERMINAL DR
Mailing Address - Street 2:SUITE 8
Mailing Address - City:EAST ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62024-2201
Mailing Address - Country:US
Mailing Address - Phone:618-258-0485
Mailing Address - Fax:618-258-4815
Practice Address - Street 1:2 TERMINAL DR
Practice Address - Street 2:SUITE 8
Practice Address - City:EAST ALTON
Practice Address - State:IL
Practice Address - Zip Code:62024-2201
Practice Address - Country:US
Practice Address - Phone:618-258-0485
Practice Address - Fax:618-258-4815
Is Sole Proprietor?:No
Enumeration Date:2016-04-28
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014241363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily