Individual
MRS. ALISON HEACOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
725 UNIVERSITY BLVD, BEAVERCREEK, OH 45324-2640
(937) 245-7100
(937) 245-7999
Mailing address
725 UNIVERSITY BLVD, BEAVERCREEK, OH 45324-2640
(937) 245-7100
(937) 245-7999
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
002939
OH
363A00000X
Physician Assistant
25MP00322600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0072094
—
OH
Enumeration date
06/18/2006
Last updated
03/21/2018
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