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General NPI Number Information
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NPI Number | 1093986473
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Entity Type | Individual
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Provider Name | HEATHER CHURCH STAVRAKAS NP-C
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Gender | Female
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Dates
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Enumeration Date | 03/13/2008
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 329 FRIENDS LANE
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City | RIDGELAND
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State | SC
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Zip | 29936-5175
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Country | US
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Telephone | 843-525-6257
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Fax | 843-525-9418
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Provider Business Mailing Address
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Address Line | 329 FRIENDS LANE
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City | RIDGELAND
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State | SC
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Zip | 29936-5175
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Country | US
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Telephone | 843-525-6257
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Fax | 843-525-9418
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 138671
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 5003921
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 19200
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License Number State | SC
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