Provider Demographics
NPI:1194034942
Name:SCHMIDT, HEIDI MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:MARIE
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:HEIDI
Other - Middle Name:MARIE
Other - Last Name:QUACKENBUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4915 E BASELINE RD STE 112
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2966
Mailing Address - Country:US
Mailing Address - Phone:480-626-6600
Mailing Address - Fax:480-626-6604
Practice Address - Street 1:4915 E BASELINE RD STE 112
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2966
Practice Address - Country:US
Practice Address - Phone:480-626-6600
Practice Address - Fax:480-626-6604
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4742363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant