Healthcare Provider Details

I. General information

NPI: 1376949727
Provider Name (Legal Business Name): HEATHER FIX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2014
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 STATE ST
LA PORTE IN
46350-3115
US

IV. Provider business mailing address

8272 N 125 E
LA PORTE IN
46350-8905
US

V. Phone/Fax

Practice location:
  • Phone: 219-324-3431
  • Fax: 219-362-3802
Mailing address:
  • Phone: 219-324-9084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28174162A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: