Basic Information
| Provider Information | |||||||||
| NPI: | 1518489095 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEATH | ||||||||
| FirstName: | WAYNE | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 184 TOWN FARM RD | ||||||||
| Address2: | |||||||||
| City: | NEW GLOUCESTER | ||||||||
| State: | ME | ||||||||
| PostalCode: | 042604432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079264488 | ||||||||
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| Practice Location | |||||||||
| Address1: | 152 DRESDEN AVE | ||||||||
| Address2: | |||||||||
| City: | GARDINER | ||||||||
| State: | ME | ||||||||
| PostalCode: | 043452615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075826608 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2017 | ||||||||
| LastUpdateDate: | 07/17/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA1725 | ME | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.