Individual
HEATHER JEAN DIETZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
420 W MAIN ST, SUITE 203, BOISE, ID 83702
(208) 429-1627
(208) 344-2104
Mailing address
420 W MAIN ST, SUITE 203, BOISE, ID 83702
(208) 429-1627
(208) 344-2104
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA565
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010151786
BLUE SHIELD NON-PAR PIN
ID
01
—
PAYF0
BLUE CROSS NON-PAR PIN
ID
Enumeration date
02/09/2007
Last updated
07/21/2022
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