Individual
MRS. HEATHER LYNNE MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3495 S 4TH ST, TERRE HAUTE, IN 47802-5501
(812) 220-4755
(812) 231-4475
Mailing address
3495 S 4TH ST, TERRE HAUTE, IN 47802-5501
(812) 220-4755
(812) 231-4475
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
5601002771
MI
363AM0700X
Medical Physician Assistant
Primary
10001212A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0852915110
BC PIN
MI
01
—
1010612
MCLAREN
MI
Enumeration date
05/24/2006
Last updated
04/09/2024
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