Individual
HEIDI ANN CRUISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2500 NE NEFF RD, BEND, OR 97701-6015
(541) 388-1636
(541) 388-1719
Mailing address
PO BOX 5579, BEND, OR 97708-5579
(541) 388-1636
(541) 388-1719
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
3096
AZ
363A00000X
Physician Assistant
3285
AZ
363A00000X
Physician Assistant
Primary
PA01270
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500606010
—
OR
Enumeration date
01/27/2006
Last updated
06/05/2023
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