Provider Demographics
NPI:1891238044
Name:MCDONOUGH, HEIDI (FNP-C)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71122
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28272-1122
Mailing Address - Country:US
Mailing Address - Phone:804-559-6980
Mailing Address - Fax:804-559-6982
Practice Address - Street 1:8400 N RUN MEDICAL DR STE 200
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2319
Practice Address - Country:US
Practice Address - Phone:804-559-6980
Practice Address - Fax:804-559-6982
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174262363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily