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General NPI Number Information
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NPI Number | 1962459941
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Entity Type | Individual
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Provider Name | JACQUELINE L. HEISER D.O.
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Gender | Female
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 06/01/2015
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Provider Practice Location Address
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Address Line | 265 W UNION ST STE A
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City | ATHENS
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State | OH
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Zip | 45701-2313
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Country | US
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Telephone | 740-594-2456
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Fax | 740-594-9630
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Provider Business Mailing Address
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Address Line | 126 PARKS HALL
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City | ATHENS
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State | OH
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Zip | 45701-1359
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Country | US
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Telephone | 740-593-4609
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Fax | 740-593-4166
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 34-007066
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 1914
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 34.007066
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License Number State | OH
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