Provider Demographics
NPI:1558395699
Name:HEISER, AMY KAYE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:KAYE
Last Name:HEISER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:KAYE
Other - Last Name:WARWAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:505 NE 87TH AVE
Mailing Address - Street 2:SUITE 46.5
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-1989
Mailing Address - Country:US
Mailing Address - Phone:360-828-5396
Mailing Address - Fax:360-828-5455
Practice Address - Street 1:2211 NE 139TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-2742
Practice Address - Country:US
Practice Address - Phone:360-828-5396
Practice Address - Fax:360-828-5455
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR099006538RN367500000X
WAAP30007378367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8945278OtherCRIME VICTIMS
WA9649245Medicaid
WA0224455OtherLABOR & INDUSTRIES
WA8867778Medicare PIN