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General NPI Number Information
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NPI Number | 1104759034
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Entity Type | Organization
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Legal Business Name | ROOTED FUNCTIONAL & FAMILY MEDICINE
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Dates
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Enumeration Date | 06/08/2026
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Last Update Date | 06/08/2026
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Provider Practice Location Address
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Address Line | 508 E STATE ROAD 32
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City | WESTFIELD
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State | IN
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Zip | 46074-8767
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Country | US
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Telephone | 765-338-7045
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Fax |
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Provider Business Mailing Address
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Address Line | 19170 DONELSON CT
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City | WESTFIELD
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State | IN
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Zip | 46062-0018
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER/MEMBER
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Name | JUSTIN SWENEY
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Credential | FNP-C
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Telephone | 765-338-7045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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