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Individual

HEIDI E WIMBERLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
2600 KINGS HWY, DEPARTMENT OF RADIATION ONCOLOGY, SHREVEPORT, LA 71103-3950
(318) 212-4639
(318) 212-8305
Mailing address
2600 KINGS HWY, DEPARTMENT OF RADIATION ONCOLOGY, SHREVEPORT, LA 71103-3950
(318) 212-4639
(318) 212-8305

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA200094RX
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1706566
LA
Enumeration date
10/23/2006
Last updated
01/13/2011
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