Provider Demographics
NPI:1225297534
Name:HEINTZELMAN, ASHLEY JO (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:JO
Last Name:HEINTZELMAN
Suffix:
Gender:F
Credentials:PA-C
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:57323 HIDDEN TIMBERS DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-8701
Mailing Address - Country:US
Mailing Address - Phone:586-871-8044
Mailing Address - Fax:
Practice Address - Street 1:47601 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1233
Practice Address - Country:US
Practice Address - Phone:248-465-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005247363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant