Individual
HEATHER DIANE HARGRAVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-S
Contact information
Practice address
635 E BASELINE RD, PHOENIX, AZ 85042
(602) 243-7277
Mailing address
635 E BASELINE RD, PHOENIX, AZ 85042-6551
(602) 243-7277
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
7586
AZ
Other
Enumeration date
10/24/2018
Last updated
09/11/2019
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