Provider Demographics
NPI:1629272562
Name:MCDONNELL, HEATHER KATHLEEN (BSN, RN, CCM)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:KATHLEEN
Last Name:MCDONNELL
Suffix:
Gender:F
Credentials:BSN, RN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 DOMINION CREST DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-7027
Mailing Address - Country:US
Mailing Address - Phone:631-645-7757
Mailing Address - Fax:
Practice Address - Street 1:9900 DOMINION CREST DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-7027
Practice Address - Country:US
Practice Address - Phone:631-645-7757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC290226163WC0400X, 163WM0102X, 163WX0002X, 163WP1700X
NY527260163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP1700XNursing Service ProvidersRegistered NursePerinatal
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk