MEDICARE: HEATHER N DAVIDSON 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	363AM0700X	Medical Physician Assistant	PA01297	OR
2	363A00000X	Physician Assistant	PA01297	OR

General Provider Information

NPI Number	:	1023292547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER N DAVIDSON PA-C

Provider Business Mailing Address
First Line	:	PO BOX 3158
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-3158
Country	:	US
Telephone Number	:	503-215-6494
Fax Number	:

Provider Business Practice Location Address
First Line	:	10670 NE CORNELL RD STE 300
Second Line	:
City	:	HILLSBORO
State	:	OR
Zip	:	97124-9221
Country	:	US
Telephone Number	:	503-216-9300
Fax Number	:

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

Provider Enumeration Date	:	12/19/2007
Last Update Date	:	10/02/2020

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