Provider Demographics
NPI:1740354695
Name:FRIEDT, HEATHER L (PAC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:FRIEDT
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 MARLOW ST
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-1562
Mailing Address - Country:US
Mailing Address - Phone:330-535-3396
Mailing Address - Fax:330-535-4415
Practice Address - Street 1:20 OLIVE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-3165
Practice Address - Country:US
Practice Address - Phone:330-535-3396
Practice Address - Fax:330-535-4415
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPA23742Medicare PIN
OHFRPA23741Medicare ID - Type Unspecified