Basic Information
| Provider Information | |||||||||
| NPI: | 1699882175 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEINTZ | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9040 | ||||||||
| Address2: | |||||||||
| City: | ALTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620029040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184620499 | ||||||||
| FaxNumber: | 6184621150 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 SAINT ANTHONYS WAY | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | ALTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620024569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184658019 | ||||||||
| FaxNumber: | 6184635004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2006 | ||||||||
| LastUpdateDate: | 09/20/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 085002576 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.