Basic Information
| Provider Information | |||||||||
| NPI: | 1518395763 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVIS-REMACLE | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 825 SE BISHOP BLVD | ||||||||
| Address2: | STE 200 | ||||||||
| City: | PULLMAN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 991635517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093322517 | ||||||||
| FaxNumber: | 5093349247 | ||||||||
| Practice Location | |||||||||
| Address1: | 825 SE BISHOP BLVD | ||||||||
| Address2: | STE 200 | ||||||||
| City: | PULLMAN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 991635517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093322517 | ||||||||
| FaxNumber: | 5093349247 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2013 | ||||||||
| LastUpdateDate: | 06/22/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA-1132 | ID | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | PA60427963 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 2033528 | 01 | WA | PROVIDER ONE | OTHER | 323971 | 01 | ID | L & I (NON NETWORK) | OTHER | P01341941 | 01 | ID | RR MEDICARE | OTHER |