Provider Demographics
NPI:1225308026
Name:GOOD, HEATHER BRONWYN (PA)
Entity Type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:BRONWYN
Last Name:GOOD
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:275 SE CABOT DR STE B102
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-3740
Mailing Address - Country:US
Mailing Address - Phone:360-675-5555
Mailing Address - Fax:360-675-0275
Practice Address - Street 1:275 SE CABOT DR STE B102
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277
Practice Address - Country:US
Practice Address - Phone:360-675-5555
Practice Address - Fax:360-675-0275
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2019-05-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAPA60261659363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical