Healthcare Provider Details

I. General information

NPI: 1467127886
Provider Name (Legal Business Name): HEIDI SUZANNE CAMMER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2021
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 E CHURCH ST STE 1
CHERRYVILLE NC
28021-2968
US

IV. Provider business mailing address

2910 EAST FRANKLIN BLVD SUITE 1
GASTONIA NC
28056-7225
US

V. Phone/Fax

Practice location:
  • Phone: 704-435-5227
  • Fax:
Mailing address:
  • Phone: 704-648-0460
  • Fax: 855-446-7146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5015016
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: