Provider Demographics
NPI:1730627019
Name:MERCY, HEATHER
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MERCY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:LUNDBORG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2896 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05471-3011
Mailing Address - Country:US
Mailing Address - Phone:802-393-9001
Mailing Address - Fax:
Practice Address - Street 1:15 SEDGEBROOK CT
Practice Address - Street 2:APARTMENT 301
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-7263
Practice Address - Country:US
Practice Address - Phone:802-393-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program