Provider Demographics
NPI:1053880781
Name:DAVIS, HEATHER DAWN (APRN,FNP-C)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:DAWN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APRN,FNP-C
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:D
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:IL
Mailing Address - Zip Code:62906-1652
Mailing Address - Country:US
Mailing Address - Phone:618-833-5161
Mailing Address - Fax:618-833-9034
Practice Address - Street 1:1000 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:IL
Practice Address - Zip Code:62906-1652
Practice Address - Country:US
Practice Address - Phone:618-833-5161
Practice Address - Fax:618-833-9034
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018023363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner