Provider Demographics
NPI:1801122551
Name:RENIHAN, HEATHER DAWN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:DAWN
Last Name:RENIHAN
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:287 MAIN ST
Mailing Address - Street 2:STE 404
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7054
Mailing Address - Country:US
Mailing Address - Phone:207-795-2171
Mailing Address - Fax:207-795-8330
Practice Address - Street 1:287 MAIN ST
Practice Address - Street 2:STE 404
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7054
Practice Address - Country:US
Practice Address - Phone:207-795-2171
Practice Address - Fax:207-795-8330
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2011-12-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MEPA1313363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant