Provider Demographics
NPI:1154307692
Name:HAUSMAN, HEATHER A (PAC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:A
Last Name:HAUSMAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 NORTH 12TH STREET
Mailing Address - Street 2:STE 2B
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-1101
Mailing Address - Country:US
Mailing Address - Phone:610-377-0990
Mailing Address - Fax:610-377-2099
Practice Address - Street 1:281 NORTH 12TH STREET
Practice Address - Street 2:STE 2B
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-1101
Practice Address - Country:US
Practice Address - Phone:610-377-0990
Practice Address - Fax:610-377-2099
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA051952363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ29405Medicare UPIN
Q29405Medicare UPIN
093612MGUMedicare Oscar/Certification