Provider Demographics
NPI:1699128892
Name:HOWELL, HEATHER L (APN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:HOWELL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:L
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:5101 N EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-4868
Mailing Address - Country:US
Mailing Address - Phone:309-677-0700
Mailing Address - Fax:309-677-0701
Practice Address - Street 1:5101 N EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4868
Practice Address - Country:US
Practice Address - Phone:309-677-0700
Practice Address - Fax:309-677-0701
Is Sole Proprietor?:No
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-014586363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner