Provider Demographics
NPI:1922114347
Name:JAMES, HEATHER R (PA-C)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:R
Last Name:JAMES
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:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:800-326-2250
Mailing Address - Fax:
Practice Address - Street 1:3400 UNION AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-8426
Practice Address - Country:US
Practice Address - Phone:920-828-2700
Practice Address - Fax:920-828-2905
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1822363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI14825OtherNETWORK HEALTH
WIP00192602OtherMEDICARE RAILROAD
WI41998200Medicaid
WI41998200Medicaid
WIP00192602OtherMEDICARE RAILROAD
Q32993Medicare UPIN