Provider Demographics
NPI:1467687103
Name:EID, HEATHER NICOLE (IDMT)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:NICOLE
Last Name:EID
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:MRS
Other - First Name:HEATHER
Other - Middle Name:NICOLE
Other - Last Name:EID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IDMT
Mailing Address - Street 1:5554 WHISPERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DALZELL
Mailing Address - State:SC
Mailing Address - Zip Code:29040-9670
Mailing Address - Country:US
Mailing Address - Phone:803-840-5066
Mailing Address - Fax:
Practice Address - Street 1:5554 WHISPERWOOD DR
Practice Address - Street 2:
Practice Address - City:DALZELL
Practice Address - State:SC
Practice Address - Zip Code:29040-9670
Practice Address - Country:US
Practice Address - Phone:803-840-5066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians