Healthcare Provider Details

I. General information

NPI: 1053604843
Provider Name (Legal Business Name): HEATHER M DENGER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER M MURDICK RN

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 N SENATE BLVD SUITE 635
INDIANAPOLIS IN
46202-1212
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-271-2800
  • Fax: 317-278-1010
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28133774A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71003645A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number71003645A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: