Healthcare Provider Details

I. General information

NPI: 1912603697
Provider Name (Legal Business Name): REBEKAH RUTH HEYEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2023
Last Update Date: 02/03/2023
Certification Date: 01/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1788 EAST STATE ROAD 163
CLINTON IN
47842
US

IV. Provider business mailing address

PO BOX 545
CLINTON IN
47842-0545
US

V. Phone/Fax

Practice location:
  • Phone: 765-592-3381
  • Fax: 765-820-1105
Mailing address:
  • Phone: 765-592-3381
  • Fax: 765-820-1105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71013516A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71013516B
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: