Individual
HEATHER J BRUCKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
705 RILEY HOSPITAL DR, INDIANAPOLIS, IN 46202-5109
(317) 274-4779
(317) 948-9806
Mailing address
PO BOX 778912, CHICAGO, IL 60677-8912
(317) 777-6435
(317) 777-6644
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
28140695
IN
363LN0000X
Neonatal Nurse Practitioner
Primary
71005548
IN
363LN0005X
Critical Care Neonatal Nurse Practitioner
71005548A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
090540996
MEDICARE PTAN
IN
01
—
1102404093
ANTHEM PTAN
IN
05
—
201327820
—
IN
Enumeration date
07/09/2015
Last updated
06/13/2024
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