Provider Demographics
NPI:1588431688
Name:SMITH, HEATHER NICHOLE
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:NICHOLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9805 N COUNTY ROAD 525 E
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-9792
Mailing Address - Country:US
Mailing Address - Phone:812-530-1327
Mailing Address - Fax:
Practice Address - Street 1:357 TANGER BLVD STE 215
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-3597
Practice Address - Country:US
Practice Address - Phone:812-716-7326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27069781A164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse