Provider Demographics
NPI:1386132355
Name:CHRISS, HEIDI A (PA-C)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:A
Last Name:CHRISS
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 1:1170 CHARTER DR STE B
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3587
Mailing Address - Country:US
Mailing Address - Phone:810-877-6343
Mailing Address - Fax:
Practice Address - Street 1:1170 CHARTER DR STE B
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3587
Practice Address - Country:US
Practice Address - Phone:810-877-6343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601008629363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant