Individual
HEATHER MICHELLE RIDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4437 MAIN ST, SHALLOTTE, NC 28470-4451
(910) 754-4449
Mailing address
4437 MAIN ST, SHALLOTTE, NC 28470-4451
(910) 754-4449
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
72318
NC
Other
Enumeration date
06/10/2020
Last updated
06/10/2020
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