Provider Demographics
NPI:1548248727
Name:HEIDEN, CARLA J (PA C)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:J
Last Name:HEIDEN
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 WIND RIDGE DRIVE
Mailing Address - Street 2:CARDIOVASCULAR ASSOCIATES
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401
Mailing Address - Country:US
Mailing Address - Phone:715-847-2611
Mailing Address - Fax:715-847-2465
Practice Address - Street 1:500 WIND RIDGE DRIVE
Practice Address - Street 2:CARDIOVASCULAR ASSOCIATES
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401
Practice Address - Country:US
Practice Address - Phone:715-847-2611
Practice Address - Fax:715-847-2465
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1912-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42876700Medicaid
Q54953Medicare UPIN