Healthcare Provider Details

I. General information

NPI: 1326328329
Provider Name (Legal Business Name): HEIDI MILLSPAUGH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 N LINCOLN RD
ROCKVILLE IN
47872-1117
US

IV. Provider business mailing address

727 N LINCOLN RD
ROCKVILLE IN
47872-1117
US

V. Phone/Fax

Practice location:
  • Phone: 765-569-1123
  • Fax: 765-569-6412
Mailing address:
  • Phone: 765-569-1123
  • Fax: 765-569-6412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28139184A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number71003670
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: