Healthcare Provider Details

I. General information

NPI: 1962460576
Provider Name (Legal Business Name): HEATHER SCHALON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER KRZEMINSKI PA

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NE 92ND AVE
VANCOUVER WA
98664-3225
US

IV. Provider business mailing address

PO BOX 5037 UNIT 282
PORTLAND OR
97208-5037
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-2142
  • Fax: 360-514-6820
Mailing address:
  • Phone: 360-514-2142
  • Fax: 360-514-6820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA153773
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10005048
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberPA16552
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: