Provider Demographics
NPI:1093068017
Name:GEORGE, HEATHER M (PA-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:GEORGE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:127 S. 500 E
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1971
Mailing Address - Country:US
Mailing Address - Phone:801-587-6336
Mailing Address - Fax:801-715-8228
Practice Address - Street 1:30 N 1900 E
Practice Address - Street 2:1R27
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-2119
Practice Address - Country:US
Practice Address - Phone:801-581-4695
Practice Address - Fax:801-585-5546
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2023-01-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT6124860-1206363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical