Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 107150 | GA |
NPI | 1053858357 |
---|---|
Provider Name | Adrienne Heath |
First Address | Durham, NC 27713-7575 |
Second Address | Raleigh, NC 27603-1802 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2017 |
Last Update Date | 24/01/2017 |