MEDICARE: HEIDI ANITA TIJSSELING DVM

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	174M00000X	Veterinarian	16363	CA

General Provider Information

NPI Number	:	1134414279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI ANITA TIJSSELING DVM

Provider Business Mailing Address
First Line	:	205 POND VIEW LN
Second Line	:
City	:	NEWCASTLE
State	:	CA
Zip	:	95658-9417
Country	:	US
Telephone Number	:	916-769-4690
Fax Number	:

Provider Business Practice Location Address
First Line	:	803 READING ST
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95630-3216
Country	:	US
Telephone Number	:	916-985-4700
Fax Number	:

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

Provider Enumeration Date	:	06/16/2011
Last Update Date	:	06/16/2011

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