Provider Demographics
NPI:1790933349
Name:NELSON, HEATHER C
Entity Type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:C
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 BRANDON QUAY
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-8543
Mailing Address - Country:US
Mailing Address - Phone:757-382-0957
Mailing Address - Fax:
Practice Address - Street 1:2040 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23324-3004
Practice Address - Country:US
Practice Address - Phone:757-543-9632
Practice Address - Fax:757-494-1721
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA020201199183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist