Provider Demographics
NPI:1992188346
Name:DIMMITT, HEATHER (MEDICAL STUDENT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:DIMMITT
Suffix:
Gender:F
Credentials:MEDICAL STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4733 21ST AVE NE
Mailing Address - Street 2:APARTMENT 204
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-6670
Mailing Address - Country:US
Mailing Address - Phone:904-993-1317
Mailing Address - Fax:
Practice Address - Street 1:4733 21ST AVE NE
Practice Address - Street 2:APARTMENT 204
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-6670
Practice Address - Country:US
Practice Address - Phone:904-993-1317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program