Provider Demographics
NPI:1922345867
Name:CHRISTENSEN, HEATHER (PA)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:9425 N NEVADA ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-5014
Mailing Address - Country:US
Mailing Address - Phone:509-465-8885
Mailing Address - Fax:509-789-9013
Practice Address - Street 1:689 AIRPORT CENTER SUITE B
Practice Address - Street 2:
Practice Address - City:FRIDAY HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98250-9825
Practice Address - Country:US
Practice Address - Phone:360-378-1338
Practice Address - Fax:509-789-9013
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-1003363A00000X
WA60445208363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical