| NPI | 1104496538 |
|---|---|
| Former Name | HEIDI KRISTINE NELSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: DE I3-0011441) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG003785) |
| Enumeration Date | 2021-06-28 |
| Last Update Date | 2022-01-24 |