MEDICARE: MS. COLLEEN ERIN HEIBY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	MA057237	PA
2	363AM0700X	Medical Physician Assistant	52294	CA

General Provider Information

NPI Number	:	1407254162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. COLLEEN ERIN HEIBY PA-C

Provider Business Mailing Address
First Line	:	858 42ND ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95819-2726
Country	:	US
Telephone Number	:	607-341-8020
Fax Number	:

Provider Business Practice Location Address
First Line	:	8735 SIERRA COLLEGE BLVD STE 200
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-5992
Country	:	US
Telephone Number	:	916-771-2531
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2014
Last Update Date	:	10/12/2022

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