Provider Demographics
NPI:1083654040
Name:HELLER, CARLA MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:MARIE
Last Name:HELLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:MARIE
Other - Last Name:HOFFERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-7182
Mailing Address - Fax:605-328-7182
Practice Address - Street 1:521 E SIOUX AVE
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-3142
Practice Address - Country:US
Practice Address - Phone:605-945-5560
Practice Address - Fax:605-224-0369
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0392363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD2294OtherDAKOTACARE
SD4994958OtherBCBS
SD32164OtherSVHP
SD6825832Medicaid
SD4994958OtherBCBS
SDS101409Medicare PIN