Provider Demographics
NPI:1689722027
Name:THORESON, HEIDI M (PA-C)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:M
Last Name:THORESON
Suffix:
Gender:F
Credentials:PA-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 1:920 4TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:PIPESTONE
Mailing Address - State:MN
Mailing Address - Zip Code:56164-1455
Mailing Address - Country:US
Mailing Address - Phone:507-825-5700
Mailing Address - Fax:507-825-4752
Practice Address - Street 1:920 4TH AVE SW
Practice Address - Street 2:
Practice Address - City:PIPESTONE
Practice Address - State:MN
Practice Address - Zip Code:56164-1455
Practice Address - Country:US
Practice Address - Phone:507-825-5700
Practice Address - Fax:507-825-4752
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2013-09-27
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN10239OtherLICENSE
MN128473000Medicaid
MN970003396Medicare PIN