MEDICARE: HEATHER RENAE GREGG NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	71005830A	IN

General Provider Information

NPI Number	:	1720244130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER RENAE GREGG NP-C

Provider Business Mailing Address
First Line	:	8450 NORTHWEST BLVD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46278-1381
Country	:	US
Telephone Number	:	317-802-2000
Fax Number	:	317-802-2017

Provider Business Practice Location Address
First Line	:	10995 ALLISONVILLE RD
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46038-2616
Country	:	US
Telephone Number	:	317-915-8110
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2008
Last Update Date	:	05/08/2024

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