Provider Demographics
NPI:1053748780
Name:SCHAUBACH, HEATHER L (PA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:SCHAUBACH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3821 ED DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8038
Mailing Address - Country:US
Mailing Address - Phone:919-758-8677
Mailing Address - Fax:919-758-8723
Practice Address - Street 1:3821 ED DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8038
Practice Address - Country:US
Practice Address - Phone:919-758-8677
Practice Address - Fax:919-758-8723
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110004387363A00000X
NC0010-12112363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1053748780Medicaid
VA1053748780Medicaid