Provider Demographics
NPI:1942839923
Name:HEERINGA, MARIANNE BUTLER (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARIANNE
Middle Name:BUTLER
Last Name:HEERINGA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 LAKE LYMAN HTS
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29365-9759
Mailing Address - Country:US
Mailing Address - Phone:864-329-7437
Mailing Address - Fax:
Practice Address - Street 1:443 CONGAREE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2742
Practice Address - Country:US
Practice Address - Phone:864-329-7437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC105134163WN1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN1003XNursing Service ProvidersRegistered NurseNutrition Support
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC105134OtherSCLLR