Provider Demographics
NPI:1457825549
Name:BIRMINGHAM, HEATHER MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MARIE
Last Name:BIRMINGHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:MARIE
Other - Last Name:HIMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13719 ENGER RD
Mailing Address - Street 2:
Mailing Address - City:POSEN
Mailing Address - State:MI
Mailing Address - Zip Code:49776-9218
Mailing Address - Country:US
Mailing Address - Phone:989-464-6183
Mailing Address - Fax:
Practice Address - Street 1:105 ARBOR LN
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1301
Practice Address - Country:US
Practice Address - Phone:989-884-0139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601008937363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant