Provider Demographics
NPI:1023539004
Name:LUTZ, HEATHER LYNN (NP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:LUTZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:L
Other - Last Name:HARDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1150 CORAL SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IN
Mailing Address - Zip Code:46034-9213
Mailing Address - Country:US
Mailing Address - Phone:317-373-3700
Mailing Address - Fax:
Practice Address - Street 1:18051 RIVER RD STE 105
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062-7093
Practice Address - Country:US
Practice Address - Phone:317-570-7900
Practice Address - Fax:317-570-2286
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71007234A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300004645Medicaid