Individual
HEATHER RENAE PADUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
1000 E MOUNTAIN BLVD, WILKES BARRE, PA 18711-0027
(570) 808-6026
(570) 808-3298
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 271-6144
(570) 271-6578
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA002736L
PA
363AM0700X
Medical Physician Assistant
MA-002736-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
150315K9M
MEDICARE PTAN
PA
Enumeration date
05/17/2006
Last updated
01/07/2021
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