Provider Demographics
NPI:1063829471
Name:HEATHER DRIESSEN, DPM, LLC
Entity Type:Organization
Organization Name:HEATHER DRIESSEN, DPM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:DRIESSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:216-554-3030
Mailing Address - Street 1:4072 CORNER STROLL LANE
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-1158
Mailing Address - Country:US
Mailing Address - Phone:216-554-3030
Mailing Address - Fax:
Practice Address - Street 1:4072 CORNER STROLL LN
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-1158
Practice Address - Country:US
Practice Address - Phone:216-554-3030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001173213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty