Provider Demographics
NPI:1962918946
Name:HEATH, VENESSA LORRAINE (PA-C)
Entity type:Individual
Prefix:
First Name:VENESSA
Middle Name:LORRAINE
Last Name:HEATH
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 1:2000 W MARINE VIEW DR BLDG 2010
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98207-5000
Mailing Address - Country:US
Mailing Address - Phone:425-304-4162
Mailing Address - Fax:
Practice Address - Street 1:2000 W MARINE VIEW DR BLDG 2010
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98207-6985
Practice Address - Country:US
Practice Address - Phone:425-304-4162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-28
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9110903363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant