Healthcare Provider Details

I. General information

NPI: 1417555251
Provider Name (Legal Business Name): ALEAH DRISCOLL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2020
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 NE NEFF RD STE 302
BEND OR
97701-4279
US

IV. Provider business mailing address

PO BOX 670
BEND OR
97709-0670
US

V. Phone/Fax

Practice location:
  • Phone: 541-706-6915
  • Fax: 541-706-6733
Mailing address:
  • Phone: 877-708-1119
  • Fax: 541-278-8349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA61114022
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: