Provider Demographics
NPI:1811426422
Name:MOONEYHAN, HEATHER (MSN, APN, CNM)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MOONEYHAN
Suffix:
Gender:F
Credentials:MSN, APN, CNM
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:KAUP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:45 MEADOWLANDS PKWY UNIT 403
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-2973
Mailing Address - Country:US
Mailing Address - Phone:772-359-8077
Mailing Address - Fax:
Practice Address - Street 1:57 U.S. 46
Practice Address - Street 2:SUITE #300
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840
Practice Address - Country:US
Practice Address - Phone:908-509-1801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME00061901367A00000X
NJ26NJ00736700363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health