Provider Demographics
NPI:1215952734
Name:MEREDITH HEON, MONICA S (NP)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:S
Last Name:MEREDITH HEON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:MONICA
Other - Middle Name:S
Other - Last Name:MEREDITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-0001
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:55 LAKE AVE N
Practice Address - Street 2:DEPARTMENT OF CARDIOLOGY
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655-0002
Practice Address - Country:US
Practice Address - Phone:508-856-2948
Practice Address - Fax:508-856-1550
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA211422363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0703834Medicaid
MA0703834Medicaid
MANP5097Medicare PIN