Provider Demographics
NPI:1942797584
Name:DEWITZ, HEATHER MICHELLE (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MICHELLE
Last Name:DEWITZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 S PLEASANTBURG DR STE 103
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2445
Mailing Address - Country:US
Mailing Address - Phone:864-558-0200
Mailing Address - Fax:
Practice Address - Street 1:850 S PLEASANTBURG DR STE 103
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2445
Practice Address - Country:US
Practice Address - Phone:864-558-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21828363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily