Thomas W Hefner, NP
Individual provider Active NPI Family Nurse Practitioner · Bonnie, IL
NPI 1750866620 · NPPES record last updated Sep 26, 2018
Key facts
- NPI
- 1750866620
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 209.018248 (IL)
- Practice address
- 365 W 3Rd St
Bonnie, IL 62816-1002 - Phone
- (618) 967-2666
- NPI assigned
- Sep 26, 2018
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209.018248 | IL | MD | Family Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 209.018248 | IL | Yes |
Addresses
Primary practice location
365 W 3Rd St
Bonnie, IL 62816-1002
Mailing address
365 W 3Rd St
Bonnie, IL 62816-1002
Phone (618) 967-2666
Other practice location 1
365 W 3rd St
Bonnie, IL 62816-1002
Phone (618) 967-2666
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 26, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.