Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | F000286-1 | NY |
NPI | 1003875998 |
---|---|
Provider Name | Ms. Heather Margaret Clarke |
First Address | Greenville, SC 29605-4253 |
Second Address | Greenville, SC 29605-4253 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 24/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S58191 | (02) |