Individual
BRIAN HECKATHORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
835 S VAN BUREN ST, GREEN BAY, WI 54301-3526
(920) 433-0111
Mailing address
835 S VAN BUREN ST, GREEN BAY, WI 54301-3526
(920) 433-0111
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
09/13/2021
Last updated
12/30/2021
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