Individual
MRS. HEATHER RAE WILLETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
8075 N SHADELAND AVE STE 200, INDIANAPOLIS, IN 46250
(317) 621-8500
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
(317) 621-7547
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10002408A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
266180B23
TRAD MEDICARE
IN
05
—
300010814
—
IN
01
—
P02006316
RR MEDICARE
IN
Enumeration date
06/30/2010
Last updated
06/05/2024
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