Provider Demographics
NPI:1770920597
Name:HEINS, ANASTASIA SERGEEVNA (PA-C)
Entity type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:SERGEEVNA
Last Name:HEINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANASTASIA
Other - Middle Name:SERGEEVNA
Other - Last Name:RODIONOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1708 YAKIMA AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5307
Mailing Address - Country:US
Mailing Address - Phone:253-426-4420
Mailing Address - Fax:253-426-4383
Practice Address - Street 1:1708 YAKIMA AVE
Practice Address - Street 2:STE 105
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5307
Practice Address - Country:US
Practice Address - Phone:253-426-4420
Practice Address - Fax:253-426-4383
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60351859363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0312567OtherL&I
WAG8920923OtherMEDICARE