Provider Demographics
NPI:1366755829
Name:CAUSSEAUX, HEATHER BLACKSTOCK (NP-C)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:BLACKSTOCK
Last Name:CAUSSEAUX
Suffix:
Gender:F
Credentials:NP-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3289 WOODBURN RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-6800
Mailing Address - Country:US
Mailing Address - Phone:571-389-7140
Mailing Address - Fax:703-992-7584
Practice Address - Street 1:3289 WOODBURN RD
Practice Address - Street 2:SUITE 130
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-6800
Practice Address - Country:US
Practice Address - Phone:571-389-7140
Practice Address - Fax:703-992-7584
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024168885363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health