Provider Demographics
NPI:1548577489
Name:CORR, HEATHER MARIE (PA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:CORR
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 1:37491 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:BURNEY
Mailing Address - State:CA
Mailing Address - Zip Code:96013-4386
Mailing Address - Country:US
Mailing Address - Phone:530-335-5457
Mailing Address - Fax:
Practice Address - Street 1:37491 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:BURNEY
Practice Address - State:CA
Practice Address - Zip Code:96013-4386
Practice Address - Country:US
Practice Address - Phone:530-335-5457
Practice Address - Fax:530-336-3060
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2013-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21134363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant