MEDICARE: HEATHER J WARD FNP

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	71001938A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000531688	OTHER	ANTHEM
3	351992146	OTHER	SAGAMORE

General Provider Information

NPI Number	:	1871537480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER J WARD FNP

Provider Business Mailing Address
First Line	:	11109 PARKVIEW PLAZA DR # 117
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	620 W NORTH ST
Second Line	:
City	:	COLUMBIA CITY
State	:	IN
Zip	:	46725-1214
Country	:	US
Telephone Number	:	260-244-0202
Fax Number	:	260-248-8255

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	10/03/2022

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