Healthcare Provider Details

I. General information

NPI: 1548609811
Provider Name (Legal Business Name): HILLARIE A. HARTZELL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 MEDICAL PARK DR STE 1000
LEWISBURG PA
17837-6343
US

IV. Provider business mailing address

1 HOSPITAL DR STE 306
LEWISBURG PA
17837-9350
US

V. Phone/Fax

Practice location:
  • Phone: 570-524-2722
  • Fax: 570-524-0362
Mailing address:
  • Phone: 570-522-4110
  • Fax: 570-768-3911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA003061
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA056147
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: