Healthcare Provider Details

I. General information

NPI: 1376947184
Provider Name (Legal Business Name): HILARY HERENDEEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2014
Last Update Date: 09/28/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601A WESTFIELD RD
NOBLESVILLE IN
46060-1323
US

IV. Provider business mailing address

PO BOX 775985
CHICAGO IL
60677-5985
US

V. Phone/Fax

Practice location:
  • Phone: 317-776-3829
  • Fax:
Mailing address:
  • Phone: 317-770-6900
  • Fax: 317-770-6911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28218627A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28218627A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: