Provider Demographics
NPI:1013094994
Name:WEBER, HEATHER (NP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:WEBER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W OLD KEY DR
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IN
Mailing Address - Zip Code:46970-9057
Mailing Address - Country:US
Mailing Address - Phone:765-475-6963
Mailing Address - Fax:765-475-2833
Practice Address - Street 1:315 W OLD KEY DR
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-9057
Practice Address - Country:US
Practice Address - Phone:765-475-6963
Practice Address - Fax:765-475-2833
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000775363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200375910Medicaid
IN151560L7Medicare PIN
500012713Medicare PIN
500012713Medicare PIN
IN151520DMedicare PIN