Provider Demographics
NPI:1649352865
Name:HEUSER, LORI S (PA-C)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:S
Last Name:HEUSER
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 1:1000 FOWLER WAY
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-5738
Mailing Address - Country:US
Mailing Address - Phone:530-621-3600
Mailing Address - Fax:530-626-7617
Practice Address - Street 1:1000 FOWLER
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-4511
Practice Address - Country:US
Practice Address - Phone:531-621-3600
Practice Address - Fax:530-626-7617
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 12494363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical