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General NPI Number Information
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NPI Number | 1285867259
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Entity Type | Individual
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Provider Name | CATHLENE MARIE HEIDEMAN ANP, LAC
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Gender | Female
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Dates
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Enumeration Date | 08/25/2009
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Last Update Date | 03/20/2017
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Provider Practice Location Address
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Address Line | 3930 PENDER DR OPTIMAL HEALTH DIMENSIONS
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City | FAIRFAX
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State | VA
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Zip | 22030-0985
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Country | US
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Telephone | 703-359-9300
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Fax |
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Provider Business Mailing Address
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Address Line | 3930 PENDER DR OPTIMAL HEALTH DIMENSIONS
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City | FAIRFAX
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State | VA
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Zip | 22030-0985
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Country | US
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Telephone | 703-359-9300
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Fax |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 0024169462
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 0121000640
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License Number State | VA
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