Provider Demographics
NPI:1699885475
Name:ABRAHAMSON, HEATHER LYNN (DO)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LYNN
Last Name:ABRAHAMSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MRS
Other - First Name:HEATHER
Other - Middle Name:LYNN
Other - Last Name:GUEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:67 EVANS RD
Mailing Address - Street 2:
Mailing Address - City:WOFFORD HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:93285-9522
Mailing Address - Country:US
Mailing Address - Phone:760-376-2276
Mailing Address - Fax:760-376-4801
Practice Address - Street 1:67 EVANS RD
Practice Address - Street 2:
Practice Address - City:WOFFORD HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:93285-9522
Practice Address - Country:US
Practice Address - Phone:760-376-2276
Practice Address - Fax:760-376-4801
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8501207Q00000X
CO44552207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A85010Medicare ID - Type UnspecifiedNORTH
H94904Medicare UPIN