Individual
AMBER R HETRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
11104 PARKVIEW CIRCLE DR STE 110, FORT WAYNE, IN 46845-1673
(260) 425-6780
(260) 425-6789
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
01079967A
IN
390200000X
Student in an Organized Health Care Education/Training Program
11017870A
IN
Other
Enumeration date
06/13/2014
Last updated
10/11/2022
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