Provider Demographics
NPI:1992259642
Name:HITESMAN, HEATHER M (ARNP)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:M
Last Name:HITESMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4028
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61204-4028
Mailing Address - Country:US
Mailing Address - Phone:563-355-9200
Mailing Address - Fax:563-355-3419
Practice Address - Street 1:1351 W. CENTRAL PARK
Practice Address - Street 2:SUITE 3300
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-1889
Practice Address - Country:US
Practice Address - Phone:563-421-0430
Practice Address - Fax:563-421-0439
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH120536363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care