Healthcare Provider Details

I. General information

NPI: 1104759034
Provider Name (Legal Business Name): ROOTED FUNCTIONAL & FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 E STATE ROAD 32
WESTFIELD IN
46074-8767
US

IV. Provider business mailing address

19170 DONELSON CT
WESTFIELD IN
46062-0018
US

V. Phone/Fax

Practice location:
  • Phone: 765-338-7045
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN SWENEY
Title or Position: NURSE PRACTITIONER/MEMBER
Credential: FNP-C
Phone: 765-338-7045