Provider Demographics
NPI:1518937903
Name:CAMPBELL, HEIDI A (RPA-C)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:A
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 LOSSON RD
Mailing Address - Street 2:STE 105
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-2379
Mailing Address - Country:US
Mailing Address - Phone:716-558-7727
Mailing Address - Fax:716-558-7720
Practice Address - Street 1:268 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-1655
Practice Address - Country:US
Practice Address - Phone:716-652-8606
Practice Address - Fax:716-805-1225
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006071363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01798801Medicaid
NYJ400066082Medicare PIN