Provider Demographics
NPI:1306390174
Name:HEISEL, AMY MARIE ELSA
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:MARIE ELSA
Last Name:HEISEL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:MARIE ELSA
Other - Last Name:FISCHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4244 OCEAN BEACH HWY
Mailing Address - Street 2:APT. 210
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-4873
Mailing Address - Country:US
Mailing Address - Phone:360-431-1124
Mailing Address - Fax:
Practice Address - Street 1:748 14TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2315
Practice Address - Country:US
Practice Address - Phone:360-200-5419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist