Individual
HEATHER KMIECIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
875 JOLIET ST, DYER, IN 46311-1920
(219) 440-7340
Mailing address
875 JOLIET ST, DYER, IN 46311-1920
(219) 440-7340
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
209019918
IL
363LF0000X
Family Nurse Practitioner
Primary
71009730A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300035005
—
IN
Enumeration date
01/04/2020
Last updated
03/11/2024
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