Provider Demographics
NPI:1780678458
Name:HEUSNER, JUDITH A (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:HEUSNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 405
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99210-0405
Mailing Address - Country:US
Mailing Address - Phone:208-667-9334
Mailing Address - Fax:208-664-2341
Practice Address - Street 1:407 E 2ND AVE
Practice Address - Street 2:#200A
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1428
Practice Address - Country:US
Practice Address - Phone:509-456-2111
Practice Address - Fax:509-456-0313
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00031782208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1110790Medicaid
F82723Medicare UPIN
WA1110790Medicaid