Provider Demographics
NPI:1942554175
Name:HARPER, HEIDI M (PA C)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:M
Last Name:HARPER
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-1720
Mailing Address - Country:US
Mailing Address - Phone:425-789-2000
Mailing Address - Fax:425-789-2096
Practice Address - Street 1:1424 BROADWAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1720
Practice Address - Country:US
Practice Address - Phone:425-789-2000
Practice Address - Fax:425-789-2096
Is Sole Proprietor?:No
Enumeration Date:2012-11-09
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60318228363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60318228OtherPA WA LICENSE
CAPA22655OtherMEDICAL LICENSE