Healthcare Provider Details

I. General information

NPI: 1023433133
Provider Name (Legal Business Name): MS. HEATHER ALISON HANNON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER ALISON YOUNG RN MSN

II. Dates (important events)

Enumeration Date: 02/26/2014
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 JOHNSTON WILLIS DR STE 100
NORTH CHESTERFIELD VA
23235-4730
US

IV. Provider business mailing address

7202 GLEN FOREST DR STE 200
RICHMOND VA
23226-3780
US

V. Phone/Fax

Practice location:
  • Phone: 804-330-7990
  • Fax: 804-330-2701
Mailing address:
  • Phone: 804-673-2024
  • Fax: 804-673-1796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number0001184428
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024173723
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: