Healthcare Provider Details

I. General information

NPI: 1346173325
Provider Name (Legal Business Name): JAKE HEPPNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10082 ILLINOIS RD
FORT WAYNE IN
46804-5772
US

IV. Provider business mailing address

5302 SUNMEADOW DR
PLAINFIELD IL
60586-7587
US

V. Phone/Fax

Practice location:
  • Phone: 260-213-4400
  • Fax:
Mailing address:
  • Phone: 815-545-5884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: