Provider Demographics
NPI:1487853776
Name:MCPHERSON, HEATHER DAWN (LPN)
Entity Type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:DAWN
Last Name:MCPHERSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-2401
Mailing Address - Country:US
Mailing Address - Phone:631-630-1656
Mailing Address - Fax:
Practice Address - Street 1:29 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-2401
Practice Address - Country:US
Practice Address - Phone:631-630-1656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270128164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse