Provider Demographics
NPI:1720732613
Name:SIDDEN, HEATHER WOLFE (RN)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:WOLFE
Last Name:SIDDEN
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 1:200 NORTHVIEW PLZ
Mailing Address - Street 2:
Mailing Address - City:N WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-3173
Mailing Address - Country:US
Mailing Address - Phone:336-818-0607
Mailing Address - Fax:
Practice Address - Street 1:200 NORTHVIEW PLZ
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3173
Practice Address - Country:US
Practice Address - Phone:336-818-0607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC210815163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC210815OtherNCBON