Provider Demographics
NPI:1528494283
Name:HECK, NICOLE L (PA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:L
Last Name:HECK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:L
Other - Last Name:POLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 W ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IN
Mailing Address - Zip Code:47832-8095
Mailing Address - Country:US
Mailing Address - Phone:765-498-9000
Mailing Address - Fax:765-498-9004
Practice Address - Street 1:201 W ACADEMY ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IN
Practice Address - Zip Code:47832-8095
Practice Address - Country:US
Practice Address - Phone:765-498-9000
Practice Address - Fax:765-498-9004
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001576A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000837406OtherANTHEM
IN000000837406OtherANTHEM