Basic Information
| Provider Information | |||||||||
| NPI: | 1447613062 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEAVIN | ||||||||
| FirstName: | LAUREN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 395 WESTFIELD RD | ||||||||
| Address2: | |||||||||
| City: | NOBLESVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460601425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177730760 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14535A HAZEL DELL PKWY | ||||||||
| Address2: | |||||||||
| City: | CARMEL | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460339401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177054360 | ||||||||
| FaxNumber: | 3177054361 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2016 | ||||||||
| LastUpdateDate: | 07/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 01082108A | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
ID Information
| ID | Type | State | Issuer | Description | 201365600 | 05 | IN | MEDICAID |