Provider Demographics
NPI:1720702228
Name:WOOLWORTH, HEATHER LEE (RN)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LEE
Last Name:WOOLWORTH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11940 S LAKE SIDE DR
Mailing Address - Street 2:
Mailing Address - City:JEROME
Mailing Address - State:MI
Mailing Address - Zip Code:49249-9650
Mailing Address - Country:US
Mailing Address - Phone:171-643-6095
Mailing Address - Fax:517-764-3659
Practice Address - Street 1:4328 PAGE AVE
Practice Address - Street 2:
Practice Address - City:MICHIGAN CENTER
Practice Address - State:MI
Practice Address - Zip Code:49254-1077
Practice Address - Country:US
Practice Address - Phone:517-764-3609
Practice Address - Fax:517-764-3659
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704238114163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse