Healthcare Provider Details

I. General information

NPI: 1548248727
Provider Name (Legal Business Name): CARLA J HEIDEN PA C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 WIND RIDGE DRIVE CARDIOVASCULAR ASSOCIATES
WAUSAU WI
54401
US

IV. Provider business mailing address

500 WIND RIDGE DRIVE CARDIOVASCULAR ASSOCIATES
WAUSAU WI
54401
US

V. Phone/Fax

Practice location:
  • Phone: 715-847-2611
  • Fax: 715-847-2465
Mailing address:
  • Phone: 715-847-2611
  • Fax: 715-847-2465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1912-023
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: