Healthcare Provider Details

I. General information

NPI: 1316022684
Provider Name (Legal Business Name): CHRISTA NICOLE HECKMAN PA-C, MPAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTA NICOLE SADRZADEH PAC, MPAS

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 UNIVERSITY AVE W FL 6
SAINT PAUL MN
55104
US

IV. Provider business mailing address

45 W. 10TH STREET
SAINT PAUL MN
55102
US

V. Phone/Fax

Practice location:
  • Phone: 651-232-2273
  • Fax: 651-232-4953
Mailing address:
  • Phone: 651-471-2623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10926
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: