Provider Demographics
NPI:1386132355
Name:CHRISS, HEIDI A (PA-C)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:A
Last Name:CHRISS
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 1:225 HOLMES RD
Mailing Address - Street 2:
Mailing Address - City:ALLENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48002-4106
Mailing Address - Country:US
Mailing Address - Phone:517-262-9572
Mailing Address - Fax:
Practice Address - Street 1:20010 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1408
Practice Address - Country:US
Practice Address - Phone:248-471-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601008629363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant