Provider Demographics
NPI:1891204376
Name:QUIST, HEIDI E (PA)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:E
Last Name:QUIST
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:ESSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6423
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-6423
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6320 W UNION HILLS DR
Practice Address - Street 2:#B2600
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1096
Practice Address - Country:US
Practice Address - Phone:602-942-5600
Practice Address - Fax:623-825-6386
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6918363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZPENDINGMedicaid