Provider Demographics
NPI:1770865495
Name:DAVIES, HEIDI (CSA)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:DAVIES
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 E VICTORY RD
Mailing Address - Street 2:APT L203
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6633
Mailing Address - Country:US
Mailing Address - Phone:208-861-3509
Mailing Address - Fax:
Practice Address - Street 1:121 E VICTORY RD
Practice Address - Street 2:APT L203
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6633
Practice Address - Country:US
Practice Address - Phone:208-861-3509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant