| NPI | 1073288320 |
|---|---|
| Former Name | HEATHER MICHELLE PRIDEMORE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: TN 32002) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 0000250924) |
| Enumeration Date | 2021-08-10 |
| Last Update Date | 2023-07-10 |