Provider Demographics
NPI:1265708036
Name:SCHMIDT, HEATHER (PA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10568 W WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-2054
Mailing Address - Country:US
Mailing Address - Phone:720-841-5961
Mailing Address - Fax:
Practice Address - Street 1:10285 RIDGE RD
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-2301
Practice Address - Country:US
Practice Address - Phone:303-463-2624
Practice Address - Fax:303-463-2650
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2044363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant