Heather A Dale, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10324 Issued in MN

Practice address

800 W College Ave
Saint Peter, MN 56082-1485

Phone

(507) 933-7630

Fax

(507) 933-6074

NPI assigned

Oct 16, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gustavus Adolphus College

  • Family Nurse Practitioner
  • Saint Peter, MN
  • NPI 1508911330
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212537600000",
    "number": "1043300205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 W COLLEGE AVE",
            "city": "SAINT PETER",
            "state": "MN",
            "postal_code": "560821485",
            "telephone_number": "507-933-7630",
            "fax_number": "507-933-6074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 W COLLEGE AVE",
            "city": "SAINT PETER",
            "state": "MN",
            "postal_code": "560821485",
            "telephone_number": "507-933-7630",
            "fax_number": "507-933-6074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DALE",
        "first_name": "HEATHER",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-16",
        "last_updated": "2008-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA504",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "10324",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN STATE LICENSE NUMBER",
            "identifier": "10324",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE #",
            "identifier": "PA504",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cornerstone Wellness Center of St.Peter P.a.
• Counseling Services of Southern Minnesota, Inc
• County of Nicollet
• County of Nicollet
• Robert Clark Dahleen Jr., D.D.S.
• Christopher D Daniels, R.PH.
• Andrew J Darchuk, PH.D.
• Emma Davis
• Lula Ahmed Dayib
• Kristin Lee Dehrkoop

• All providers in Saint Peter, MN
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.