Provider Demographics
NPI:1689874372
Name:ANDERSON, HEATHER T (NP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:T
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHINA GROVE
Mailing Address - State:NC
Mailing Address - Zip Code:28023-2471
Mailing Address - Country:US
Mailing Address - Phone:704-857-8769
Mailing Address - Fax:704-857-8779
Practice Address - Street 1:302 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHINA GROVE
Practice Address - State:NC
Practice Address - Zip Code:28023-2471
Practice Address - Country:US
Practice Address - Phone:704-857-8769
Practice Address - Fax:704-857-8779
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily