Individual
HEATHER ORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
5215 HOLY CROSS PKWY, MISHAWAKA, IN 46545-1469
(574) 335-5000
Mailing address
20149 INDIAN SCHOOL RD, LAKEVILLE, IN 46536-9784
(574) 309-3884
Taxonomy
Speciality
Code
Description
License number
State
163WP2201X
Ambulatory Care Registered Nurse
28147370A
IN
363L00000X
Nurse Practitioner
71007551A
IN
363LF0000X
Family Nurse Practitioner
Primary
71007551A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300007014
—
IN
Enumeration date
01/22/2017
Last updated
02/07/2024
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