Provider Demographics
NPI:1730172032
Name:HECK, CHERYL LYNN (NP)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:LYNN
Last Name:HECK
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:STE 130 PROVIDER ENROLLMENT
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8820 S MERIDIAN STREET
Practice Address - Street 2:SUITE 120
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46217-6057
Practice Address - Country:US
Practice Address - Phone:317-865-6700
Practice Address - Fax:317-865-6707
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71001937A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200525190Medicaid
INQ48045Medicare UPIN
IN200525190Medicaid
INP01141656Medicare PIN
IN264430OOOOMedicare PIN