Provider Demographics
NPI:1285867259
Name:HEIDEMAN, CATHLENE MARIE (ANP, LAC)
Entity Type:Individual
Prefix:
First Name:CATHLENE
Middle Name:MARIE
Last Name:HEIDEMAN
Suffix:
Gender:F
Credentials:ANP, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3930 PENDER DR
Mailing Address - Street 2:OPTIMAL HEALTH DIMENSIONS
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-0985
Mailing Address - Country:US
Mailing Address - Phone:703-359-9300
Mailing Address - Fax:
Practice Address - Street 1:3930 PENDER DR
Practice Address - Street 2:OPTIMAL HEALTH DIMENSIONS
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-0985
Practice Address - Country:US
Practice Address - Phone:703-359-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169462363LA2200X
VA0121000640171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No171100000XOther Service ProvidersAcupuncturist