Provider Demographics
NPI:1417269481
Name:HEISHMAN, MEAGAN MICHELLE (MA, RD, CD)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:MICHELLE
Last Name:HEISHMAN
Suffix:
Gender:F
Credentials:MA, RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2859
Mailing Address - Country:US
Mailing Address - Phone:317-266-2939
Mailing Address - Fax:
Practice Address - Street 1:6940 NORTH MICHIGAN RD
Practice Address - Street 2:PECAR HEALTH CENTER
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-2800
Practice Address - Country:US
Practice Address - Phone:317-266-2901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37002002A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered