Individual
JENNIFER RUTH HEISICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
8075 N SHADELAND AVE, SUITE 200, INDIANAPOLIS, IN 46250-2693
(317) 621-5676
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
28175280A
IN
363L00000X
Nurse Practitioner
Primary
71004507A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201174190
—
IN
01
—
P01261827
MEDICARE RR PTAN
IN
Enumeration date
05/16/2013
Last updated
12/03/2014
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