Individual
MRS. HEATHER CHURCH STAVRAKAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
329 FRIENDS LANE, RIDGELAND, SC 29936-5175
(843) 525-6257
(843) 525-9418
Mailing address
329 FRIENDS LANE, RIDGELAND, SC 29936-5175
(843) 525-6257
(843) 525-9418
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
138671
NC
363LA2200X
Adult Health Nurse Practitioner
Primary
19200
SC
363LA2200X
Adult Health Nurse Practitioner
5003921
NC
Other
Enumeration date
03/13/2008
Last updated
09/11/2024
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