Basic Information
| Provider Information | |||||||||
| NPI: | 1275895666 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEFFERNAN-STROUD | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | AUGUSTA | ||||||||
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| Credential: | M.D./P.H.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 YORK ST | ||||||||
| Address2: | |||||||||
| City: | MANITOWOC | ||||||||
| State: | WI | ||||||||
| PostalCode: | 542204630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9206639008 | ||||||||
| FaxNumber: | 9206841439 | ||||||||
| Practice Location | |||||||||
| Address1: | 7560 CARPENTER FIRE STATION RD STE 204 | ||||||||
| Address2: | |||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275199637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194394206 | ||||||||
| FaxNumber: | 9194399375 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2012 | ||||||||
| LastUpdateDate: | 08/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 2016-00343 | NC | Y | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | 0101259854 | VA | N | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.