Basic Information
| Provider Information | |||||||||
| NPI: | 1861448706 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BIDINGER | ||||||||
| FirstName: | HEATHER | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8170 OLD CARRIAGE CT | ||||||||
| Address2: | |||||||||
| City: | SHAKOPEE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553793163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524283600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1100 E BROADWAY ST | ||||||||
| Address2: | |||||||||
| City: | REDWOOD FALLS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 562832247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076372985 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 07/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 9423 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 101M8BI | 01 | BCBS | OTHER | HP32789 | 01 | HELATH PARTNERS | OTHER | 1023789 | 01 | PREFERRED ONE | OTHER | 411690591 | 01 | CHAMPUS | OTHER | 731157500 | 05 | MN | MEDICAID |