Provider Demographics
NPI:1033082912
Name:MCGOVERN, HEATHER D
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:D
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12004 GATWICK VIEW DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-4170
Mailing Address - Country:US
Mailing Address - Phone:765-667-9994
Mailing Address - Fax:
Practice Address - Street 1:12004 GATWICK VIEW DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-4170
Practice Address - Country:US
Practice Address - Phone:765-667-9994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-26
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28210701A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse