Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | AG0316055 | IN |
N | 363LG0600X | Nurse Practitioner - Gerontology | AG0316055 | IN |
NPI | 1043672660 |
---|---|
Provider Name | Mrs. Heather Ann Masters |
First Address | Portland, IN 47371-1322 |
Second Address | Muncie, IN 47304-3988 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2016 |
Last Update Date | 10/12/2020 |