Healthcare Provider Details

I. General information

NPI: 1801103635
Provider Name (Legal Business Name): HEATHER MARIE MECONE ARNP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER MARIE MCLAUGHLIN CNM

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 E MOUNTAIN BLVD
WILKES BARRE PA
18702
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 570-808-7916
  • Fax:
Mailing address:
  • Phone: 570-271-6144
  • Fax: 570-271-6578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number144282
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberMW010225
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1025292040001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: