Provider Demographics
NPI:1376100883
Name:CALDWELL, HEATHER MARIE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:MARIE
Last Name:CALDWELL
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:228 WEST MCDOWELL AVENUE
Mailing Address - Street 2:
Mailing Address - City:ALTURAS
Mailing Address - State:CA
Mailing Address - Zip Code:96101
Mailing Address - Country:US
Mailing Address - Phone:530-233-7052
Mailing Address - Fax:530-233-4302
Practice Address - Street 1:229 WEST MCDOWELL AVENUE
Practice Address - Street 2:
Practice Address - City:ALTURAS
Practice Address - State:CA
Practice Address - Zip Code:96101
Practice Address - Country:US
Practice Address - Phone:530-233-7052
Practice Address - Fax:530-233-4302
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA56788363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant