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Heart To Heart Pediatrics LLC

Nurse Practitioner, Pediatrics in Waterloo, IL. Organization (NPI-2).

NPI number1376192567
StatusActive
Last updated in NPPESOct 2, 2019

Details

NPI
1376192567
Entity type
Organization (NPI-2)
Legal business name
Heart To Heart Pediatrics LLC
Organization subpart
No
Enumeration date
Sep 10, 2019
Last updated
Oct 2, 2019

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LP0200X Nurse Practitioner, Pediatrics––Yes

Practice location

224 Bradford Ln
Waterloo, IL 62298-3369

Phone 618-939-0112

Mailing address

224 Bradford Ln
Waterloo, IL 62298-3369

Phone 618-939-0112

Authorized official

Ginny M Peter
Nurse Practitioner
6189390112

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