Healthcare Provider Details

I. General information

NPI: 1003217753
Provider Name (Legal Business Name): HEATHER M CAUL AG-ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2014
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13345 ILLINOIS ST
CARMEL IN
46032-3318
US

IV. Provider business mailing address

2001 W 86TH ST
INDIANAPOLIS IN
46260-1902
US

V. Phone/Fax

Practice location:
  • Phone: 317-396-1300
  • Fax: 317-352-3417
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71005139A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: