# JENNIFER RUTH HEISICK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1356787493
- **Gender:** F
- **Credential:** NP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | 28175280A | IN | — |
| 363L00000X | Nurse Practitioner | 71004507A | IN | Yes |

## Other

- **Enumeration date:** 05/16/2013
- **Last updated:** 12/03/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 201174190 | — | IN |
| 01 | — | P01261827 | MEDICARE RR PTAN | IN |