Provider Demographics
NPI:1346259439
Name:VAS, HEATHER COLLEEN (PA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:COLLEEN
Last Name:VAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:515 MINOR AVE STE 210
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104
Practice Address - Country:US
Practice Address - Phone:206-386-9500
Practice Address - Fax:206-386-9605
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS00508363A00000X
WA10003144363AM0700X
WAPA10003144363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS042561OtherBCBS
KS6603OtherPHS
KS100343120AMedicaid
KS6603OtherPHS
KS042561Medicare ID - Type Unspecified