Individual
HEIDI A TATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
24360 VAN RY BLVD STE 111, MOUNTLAKE TERRACE, WA 98043-5457
(206) 520-5000
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
(206) 520-5700
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA60107657
WA
363AM0700X
Medical Physician Assistant
PA170945
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA170945
STATE LICENSE
OR
01
—
PA60107657
STATE LICENSE
WA
Enumeration date
11/19/2009
Last updated
04/09/2024
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