Provider Demographics
NPI:1518395763
Name:DAVIS-REMACLE, HEATHER N (PA-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:N
Last Name:DAVIS-REMACLE
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 1:825 SE BISHOP BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5517
Mailing Address - Country:US
Mailing Address - Phone:509-332-2517
Mailing Address - Fax:509-334-9247
Practice Address - Street 1:825 SE BISHOP BLVD
Practice Address - Street 2:STE 200
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5517
Practice Address - Country:US
Practice Address - Phone:509-332-2517
Practice Address - Fax:509-334-9247
Is Sole Proprietor?:No
Enumeration Date:2013-10-25
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-1132363A00000X
WAPA60427963363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2033528OtherPROVIDER ONE
ID323971OtherL & I (NON NETWORK)
IDP01341941OtherRR MEDICARE
WAGAB8929079Medicare PIN
IDP01341941OtherRR MEDICARE