Provider Demographics
NPI:1427285626
Name:HECK, LISA (APN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HECK
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 1:7725 N KNOXVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-2079
Mailing Address - Country:US
Mailing Address - Phone:309-495-0240
Mailing Address - Fax:309-689-9035
Practice Address - Street 1:7725 N KNOXVILLE AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-2079
Practice Address - Country:US
Practice Address - Phone:309-495-0240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041218246163WG0000X
IL209-007836364S00000X
IL209007836363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist