Healthcare Provider Details

I. General information

NPI: 1427359496
Provider Name (Legal Business Name): HEATHER LYNNE MCDONOUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 07/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 FAIRFAX CT
SEVEN FIELDS PA
16046-7865
US

IV. Provider business mailing address

311 FAIRFAX CT
SEVEN FIELDS PA
16046-7865
US

V. Phone/Fax

Practice location:
  • Phone: 412-427-4102
  • Fax:
Mailing address:
  • Phone: 412-427-4102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN554916
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: