Provider Demographics
NPI:1184868564
Name:HOUSE, HEATHER R (CRNA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:R
Last Name:HOUSE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4829 WINDRIFT WAY
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-9508
Mailing Address - Country:US
Mailing Address - Phone:317-669-2744
Mailing Address - Fax:
Practice Address - Street 1:1000 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-1948
Practice Address - Country:US
Practice Address - Phone:317-745-3529
Practice Address - Fax:317-567-2191
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN315934367500000X
IN28188581A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000675476OtherANTHEM
IN200997400Medicaid
INPENDINGMedicaid