Individual
MRS. HEATHER LYLES GOLDFUSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4700 E OAK ISLAND DR, OAK ISLAND, NC 28465-5257
(910) 278-6416
(855) 763-1167
Mailing address
924 N HOWE ST, SOUTHPORT, NC 28461-3038
(910) 457-3800
(910) 457-3842
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0010-01344
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1063575249
NPI 1063575249
NC
Enumeration date
12/18/2006
Last updated
03/22/2017
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