Healthcare Provider Details

I. General information

NPI: 1003875998
Provider Name (Legal Business Name): HEATHER MARGARET CLARKE CNM MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 07/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 W FARIS RD SUITE 470
GREENVILLE SC
29605-4253
US

IV. Provider business mailing address

890 W FARIS RD SUITE 470
GREENVILLE SC
29605-4253
US

V. Phone/Fax

Practice location:
  • Phone: 864-455-1600
  • Fax:
Mailing address:
  • Phone: 864-455-1600
  • Fax: 864-455-3095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberM17730
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberF000286-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: