Provider Demographics
NPI:1508834045
Name:MERROW, HEATHER (PAC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MERROW
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2561
Mailing Address - Street 2:HOLDEN BEACH MEDICAL CENTER
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28459
Mailing Address - Country:US
Mailing Address - Phone:910-842-5991
Mailing Address - Fax:910-842-5994
Practice Address - Street 1:2930 HOLDEN BEACH RD
Practice Address - Street 2:
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462
Practice Address - Country:US
Practice Address - Phone:910-842-5991
Practice Address - Fax:910-842-5994
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103587363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2757618BMedicare ID - Type Unspecified
P838893Medicare UPIN