Provider Demographics
NPI:1720244130
Name:GREGG, HEATHER RENAE (NP-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:RENAE
Last Name:GREGG
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MRS
Other - First Name:HEATHER
Other - Middle Name:RENAE
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8450 NORTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-1381
Mailing Address - Country:US
Mailing Address - Phone:317-802-2000
Mailing Address - Fax:317-802-2017
Practice Address - Street 1:10995 ALLISONVILLE RD
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2616
Practice Address - Country:US
Practice Address - Phone:317-915-8110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005830A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner