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General NPI Number Information
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NPI Number | 1891238044
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Entity Type | Individual
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Provider Name | HEIDI MCDONOUGH FNP-C
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Gender | Female
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Dates
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Enumeration Date | 11/21/2016
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Last Update Date | 10/05/2018
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Provider Practice Location Address
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Address Line | 8400 N RUN MEDICAL DR STE 200
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City | MECHANICSVILLE
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State | VA
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Zip | 23116-2319
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Country | US
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Telephone | 804-559-6980
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Fax | 804-559-6982
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Provider Business Mailing Address
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Address Line | PO BOX 71122
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City | CHARLOTTE
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State | NC
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Zip | 28272-1122
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Country | US
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Telephone | 804-559-6980
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Fax | 804-559-6982
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024174262
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License Number State | VA
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