Healthcare Provider Details

I. General information

NPI: 1114399177
Provider Name (Legal Business Name): MRS. HEATHER MARIE CATLETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2015
Last Update Date: 10/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HOSS RD
INDIANAPOLIS IN
46217-3423
US

IV. Provider business mailing address

101 HOSS RD
INDIANAPOLIS IN
46217-3423
US

V. Phone/Fax

Practice location:
  • Phone: 317-447-9608
  • Fax:
Mailing address:
  • Phone: 317-447-9608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number28181022A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number221174-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: