Individual provider Active NPI

Monica Marie Heinrich

  • Gerontology Registered Nurse
  • Lake Forest, IL
National Provider Identifier
1710649454
Registry record updated Oct 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Registered NurseTaxonomy code 163WG0600X
License
041236153 Issued in IL
Practice address
1101 Pembridge Dr
Lake Forest, IL 60045-4222
Phone
(847) 604-6639
NPI assigned
Oct 11, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Registered Nurse 163WG0600X 041236153 IL Primary

Addresses

Primary practice location

1101 Pembridge Dr
Lake Forest, IL 60045-4222

Mailing address

1101 Pembridge Dr
Lake Forest, IL 60045-4222
Phone (847) 217-2477

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
041236153ILMDGerontology Registered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1633910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633910400000",
    "number": "1710649454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 PEMBRIDGE DR",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600454222",
            "telephone_number": "847-217-2477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 PEMBRIDGE DR",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600454222",
            "telephone_number": "847-604-6639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEINRICH",
        "first_name": "MONICA",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-11",
        "last_updated": "2021-10-11",
        "certification_date": "2021-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0600X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Gerontology",
            "state": "IL",
            "license": "041236153",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Forest, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.