Healthcare Provider Details

I. General information

NPI: 1932573482
Provider Name (Legal Business Name): MRS. ERIKA J MEILY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIKA J PEAVY

II. Dates (important events)

Enumeration Date: 11/20/2015
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S LINCOLN AVE
LEBANON PA
17042-7529
US

IV. Provider business mailing address

1700 S LINCOLN AVE
LEBANON PA
17042-7529
US

V. Phone/Fax

Practice location:
  • Phone: 717-373-6621
  • Fax:
Mailing address:
  • Phone: 717-272-6621
  • Fax: 717-278-5982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA058034
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA058034
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: