Provider Demographics
NPI:1548419666
Name:SANDERS, HEATHER A (PA)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:A
Last Name:SANDERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 GREYBULL AVE
Mailing Address - Street 2:
Mailing Address - City:GREYBULL
Mailing Address - State:WY
Mailing Address - Zip Code:82426-2037
Mailing Address - Country:US
Mailing Address - Phone:307-765-1450
Mailing Address - Fax:
Practice Address - Street 1:444 GREYBULL AVE
Practice Address - Street 2:
Practice Address - City:GREYBULL
Practice Address - State:WY
Practice Address - Zip Code:82426-2037
Practice Address - Country:US
Practice Address - Phone:307-765-1450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY363363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY53Z301Medicare Oscar/Certification
WY533981Medicare Oscar/Certification
WY531301Medicare Oscar/Certification
G35813Medicare UPIN
WY535019Medicare Oscar/Certification