Basic Information
Provider Information
NPI: 1003016163
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HARTSHORN
FirstName: HEATHER
MiddleName: ANNE
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: WOODRUFF
OtherFirstName: HEATHER
OtherMiddleName: ANNE
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: M.D.
OtherLastNameType: 1
Mailing Information
Address1: PO BOX 3649
Address2:  
City: SPOKANE
State: WA
PostalCode: 992203649
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1414 N HOUK RD STE 203
Address2:  
City: SPOKANE VALLEY
State: WA
PostalCode: 992161097
CountryCode: US
TelephoneNumber: 5098382531
FaxNumber: 5097556580
Other Information
ProviderEnumerationDate: 07/18/2007
LastUpdateDate: 04/27/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000X51412CON Allopathic & Osteopathic PhysiciansSurgery 
208600000XMD60514747WAY Allopathic & Osteopathic PhysiciansSurgery 

ID Information
IDTypeStateIssuerDescription
8272303605CO MEDICAID


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