Provider Demographics
NPI:1326341199
Name:RAPP, HEATHER L (PA-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:RAPP
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 1:540 PARMALEE AVE
Mailing Address - Street 2:STE 510
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44510-1716
Mailing Address - Country:US
Mailing Address - Phone:330-743-1928
Mailing Address - Fax:330-744-2110
Practice Address - Street 1:540 PARMALEE AVE
Practice Address - Street 2:STE 510
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44510-1716
Practice Address - Country:US
Practice Address - Phone:330-747-1928
Practice Address - Fax:330-744-2110
Is Sole Proprietor?:No
Enumeration Date:2010-12-16
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003210RX363A00000X
OH50003210363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0084819Medicaid
OHH176940Medicare UPIN