Provider Demographics
NPI:1902959265
Name:HEIN, SONJA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:MARIE
Last Name:HEIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 LANE 7 1/2
Mailing Address - Street 2:
Mailing Address - City:DEAVER
Mailing Address - State:WY
Mailing Address - Zip Code:82421-9704
Mailing Address - Country:US
Mailing Address - Phone:307-664-2770
Mailing Address - Fax:
Practice Address - Street 1:1231 RUMSEY AVE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3607
Practice Address - Country:US
Practice Address - Phone:307-527-5174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY193363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant