Provider Demographics
NPI:1093788655
Name:RICHTER, HEIDI C (PA-C , AT-C)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:C
Last Name:RICHTER
Suffix:
Gender:F
Credentials:PA-C , AT-C
Other - Prefix:
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Mailing Address - Street 1:1910 SASSAFRAS ST
Mailing Address - Street 2:STE 100
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2716
Mailing Address - Country:US
Mailing Address - Phone:814-456-9197
Mailing Address - Fax:814-455-2765
Practice Address - Street 1:2315 MYRTLE ST
Practice Address - Street 2:SUITE 160
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-4602
Practice Address - Country:US
Practice Address - Phone:814-456-9197
Practice Address - Fax:814-455-2765
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2016-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PART001481A2255A2300X
PAMA051826363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ24652Medicare UPIN