Healthcare Provider Details

I. General information

NPI: 1134054786
Provider Name (Legal Business Name): HEATHER BENEDICT MSN, RN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER HARTMAN

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 JOSLYN RD
LAKE ORION MI
48360-1139
US

IV. Provider business mailing address

6344 SMITHS CREEK RD
KIMBALL MI
48074-3611
US

V. Phone/Fax

Practice location:
  • Phone: 248-391-3100
  • Fax:
Mailing address:
  • Phone: 810-689-0993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704386318
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: