Healthcare Provider Details

I. General information

NPI: 1891017125
Provider Name (Legal Business Name): HEATHER MARIE ELLIOTT DEMARS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER MARIE DEMARS PA-C

II. Dates (important events)

Enumeration Date: 03/01/2010
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3495 KEYSTONE LOOP
DISCOVERY BAY CA
94505-2320
US

IV. Provider business mailing address

260 BICENTENNIAL WAY APT 811
SANTA ROSA CA
95403-7423
US

V. Phone/Fax

Practice location:
  • Phone: 603-959-8758
  • Fax:
Mailing address:
  • Phone: 603-959-8758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-261
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: