Provider Demographics
NPI:1932534229
Name:HEINE, ELAINE A (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:A
Last Name:HEINE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:A
Other - Last Name:SHERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:801 ENCINO PL NE STE F
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2639
Mailing Address - Country:US
Mailing Address - Phone:505-272-1312
Mailing Address - Fax:
Practice Address - Street 1:801 ENCINO PL NE STE F
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2639
Practice Address - Country:US
Practice Address - Phone:505-272-1312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3270363A00000X
NMPA2013-0056363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ032230Medicaid
NM47637277Medicaid