Provider Demographics
NPI:1164814760
Name:HEANEY, JENNIFER PIERCE (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:PIERCE
Last Name:HEANEY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 N MICHIGAN ST STE 400
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1081
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:610 N MICHIGAN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1077
Practice Address - Country:US
Practice Address - Phone:575-647-8120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005397A363L00000X, 363LF0000X
IN28171646A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000925950OtherBCBS BMG ADVANCED CARDIO SPECIALIST SOUTH BEND
IN201284000Medicaid
IN000000925950OtherBCBS BMG ADVANCED CARDIO SPECIALIST SOUTH BEND