Individual
HEATHER DANIELLE LASETER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1825 MARTHA BERRY BLVD NW, ROME, GA 30165-1625
(706) 295-5331
(706) 236-6432
Mailing address
221 TECHNOLOGY PKWY NW, ROME, GA 30165-1369
(762) 235-1000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
005861
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
790821108A
—
GA
05
—
790821108B
—
GA
05
—
790821108C
—
GA
05
—
790821108D
—
GA
05
—
790821108E
—
GA
05
—
790821108F
—
GA
05
—
790821108G
—
GA
Enumeration date
06/16/2010
Last updated
04/27/2020
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