Individual
HEATHER DANIELLE WALDEMAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2600 W MAIN ST, BELLEVILLE, IL 62226-6651
(208) 380-2769
Mailing address
2600 W MAIN ST, BELLEVILLE, IL 62226-6651
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
09/03/2019
Last updated
09/03/2019
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