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Individual

HEATHER A DALE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
800 W COLLEGE AVE, SAINT PETER, MN 56082-1485
(507) 933-7630
(507) 933-6074
Mailing address
800 W COLLEGE AVE, SAINT PETER, MN 56082-1485
(507) 933-7630
(507) 933-6074

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10324
MN
363A00000X
Physician Assistant
PA504
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
10324
MN STATE LICENSE NUMBER
MN
01
PA504
STATE LICENSE #
ID
Enumeration date
10/16/2006
Last updated
06/04/2008
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