Provider Demographics
NPI:1225066426
Name:AMITRONE, HEATHER L (PA-C)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:L
Last Name:AMITRONE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WELLESLEY TRADE LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-5576
Mailing Address - Country:US
Mailing Address - Phone:919-363-7546
Mailing Address - Fax:919-363-3616
Practice Address - Street 1:200 WELLESLEY TRADE LN
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-5576
Practice Address - Country:US
Practice Address - Phone:919-363-7546
Practice Address - Fax:919-363-3616
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA050980363A00000X
NC0010-12283363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P63535Medicare UPIN