Provider Demographics
NPI:1558131342
Name:ROTERING, HEIDI (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:ROTERING
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HEIDI ROTERING
Mailing Address - Street 2:12270 PINE RD
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563
Mailing Address - Country:US
Mailing Address - Phone:765-532-5116
Mailing Address - Fax:
Practice Address - Street 1:HEIDI ROTERING
Practice Address - Street 2:12270 PINE RD
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563
Practice Address - Country:US
Practice Address - Phone:765-532-5116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INL-313476163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant