Individual
HEATHER ANN MIYASHIRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
18444 N 25TH AVE STE 210, PHOENIX, AZ 85023-1264
(866) 974-2673
(866) 974-2673
Mailing address
18444 N 25TH AVE STE 310, PHOENIX, AZ 85023-1266
(866) 974-2673
(866) 939-2673
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
6952
AZ
363A00000X
Physician Assistant
PA61003115
WA
363A00000X
Physician Assistant
TL2917
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3487PA
—
SC
01
—
SCC1478510
MEDICARE
SC
01
—
SCC1479068
MEDICARE
SC
Enumeration date
01/18/2018
Last updated
03/27/2024
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