Healthcare Provider Details

I. General information

NPI: 1972268357
Provider Name (Legal Business Name): ERIN LYNNE HEFFNER AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2021
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2765 MARGESSON XING
LAFAYETTE IN
47909-8092
US

IV. Provider business mailing address

2765 MARGESSON XING
LAFAYETTE IN
47909-8092
US

V. Phone/Fax

Practice location:
  • Phone: 765-366-7343
  • Fax:
Mailing address:
  • Phone: 765-366-7343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberNA
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number71011950A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number71011950A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number123456
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberNA
License Number StateIN
# 6
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNA
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: