Provider Demographics
NPI:1740506237
Name:CARRION, HEATHER DYAN (CNM)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:DYAN
Last Name:CARRION
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:DYAN
Other - Last Name:DONALDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:1011 W BALTIMORE PIKE
Mailing Address - Street 2:STE 208
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-9446
Mailing Address - Country:US
Mailing Address - Phone:610-869-2220
Mailing Address - Fax:610-869-6550
Practice Address - Street 1:1011 W BALTIMORE PIKE
Practice Address - Street 2:STE 208
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9446
Practice Address - Country:US
Practice Address - Phone:610-869-2220
Practice Address - Fax:610-869-6550
Is Sole Proprietor?:No
Enumeration Date:2010-04-09
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW010216367A00000X
NY001364367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife