Provider Demographics
NPI:1467829499
Name:MCDONNELL, HEATHER (BSN, RN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MCDONNELL
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 GARDEN OF THE GODS RD # 2044
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-9444
Mailing Address - Country:US
Mailing Address - Phone:719-578-3199
Mailing Address - Fax:
Practice Address - Street 1:1675 GARDEN OF THE GODS RD
Practice Address - Street 2:SUITE 2044
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-9444
Practice Address - Country:US
Practice Address - Phone:719-578-3256
Practice Address - Fax:719-578-3234
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN217600163W00000X
CORN.1628010163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse