Individual
MRS. HEATHER NICOLE SELF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
640 MARTIN LUTHER KING JR BLVD STE 200, MACON, GA 31201-3297
(478) 745-5455
Mailing address
338 VENTURA DR, BYRON, GA 31008-8752
(478) 956-7886
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN232828
GA
363L00000X
Nurse Practitioner
Primary
RN232828
GA
Other
Enumeration date
12/22/2018
Last updated
07/09/2021
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