Provider Demographics
NPI:1245755792
Name:SCARBOROUGH, HEATHER R (RN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:R
Last Name:SCARBOROUGH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 RICHMOND CENTER CT
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-5973
Mailing Address - Country:US
Mailing Address - Phone:636-397-2001
Mailing Address - Fax:636-279-2010
Practice Address - Street 1:2 RICHMOND CENTER CT
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-5973
Practice Address - Country:US
Practice Address - Phone:636-397-2001
Practice Address - Fax:636-279-2010
Is Sole Proprietor?:No
Enumeration Date:2017-08-06
Last Update Date:2017-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005029851163WS0121X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery