Healthcare Provider Details

I. General information

NPI: 1720142631
Provider Name (Legal Business Name): HEATHER OVERMAN DEANES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 GOVERNMENT CIR
GREENVILLE NC
27834-8198
US

IV. Provider business mailing address

2607 ROSEWOOD DR
WINTERVILLE NC
28590-9171
US

V. Phone/Fax

Practice location:
  • Phone: 252-902-2355
  • Fax: 252-413-1446
Mailing address:
  • Phone: 252-353-6192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number166441
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: