Basic Information
Provider Information
NPI: 1497027114
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DRIEMEYER
FirstName: NENA
MiddleName: MICHELLE
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6615 VALLEY HI DR STE A
Address2:  
City: SACRAMENTO
State: CA
PostalCode: 958237076
CountryCode: US
TelephoneNumber: 9166816300
FaxNumber: 9166816354
Practice Location
Address1: 6615 VALLEY HI DR STE A
Address2:  
City: SACRAMENTO
State: CA
PostalCode: 958237076
CountryCode: US
TelephoneNumber: 9166816300
FaxNumber: 9166816354
Other Information
ProviderEnumerationDate: 01/27/2012
LastUpdateDate: 03/14/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106H00000X74417CAY Behavioral Health & Social Service ProvidersMarriage & Family Therapist 

No ID Information.


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