Provider Demographics
NPI:1477839207
Name:WHITE, HEATHER ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANNE
Last Name:WHITE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ANNE
Other - Last Name:SHUPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3855 W CHESTER PIKE
Mailing Address - Street 2:SUITE 245
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-2304
Mailing Address - Country:US
Mailing Address - Phone:610-325-3880
Mailing Address - Fax:610-325-3887
Practice Address - Street 1:3855 W CHESTER PIKE
Practice Address - Street 2:SUITE 245
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-2304
Practice Address - Country:US
Practice Address - Phone:610-325-3880
Practice Address - Fax:610-325-3887
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA002737363AS0400X
PAMA005198363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical