Provider Demographics
NPI:1922607936
Name:DIERS, ALISSE ANNA (DNP)
Entity Type:Individual
Prefix:DR
First Name:ALISSE
Middle Name:ANNA
Last Name:DIERS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:ALISSE
Other - Middle Name:ANNA DIERS
Other - Last Name:HEIDERSCHEIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP
Mailing Address - Street 1:PO BOX 1435
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-0349
Mailing Address - Country:US
Mailing Address - Phone:541-236-2088
Mailing Address - Fax:541-931-8824
Practice Address - Street 1:137 HALL AVE
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-1519
Practice Address - Country:US
Practice Address - Phone:541-236-2088
Practice Address - Fax:541-931-8824
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-21
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202108253NP-PP363LP0808X
OR202105516NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily