Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 21048 | SC |
NPI | 1003346800 |
---|---|
Provider Name | Heidi Elizabeth Walsh |
First Address | Duncan, SC 29334-8968 |
Second Address | Spartanburg, SC 29302-1631 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2017 |
Last Update Date | 21/05/2020 |