Healthcare Provider Details

I. General information

NPI: 1194550657
Provider Name (Legal Business Name): KAMRYN LIUZZO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 W OLIVE ST STE 210
SCRANTON PA
18508-2574
US

IV. Provider business mailing address

1 MORGAN ST
CARBONDALE PA
18407-2100
US

V. Phone/Fax

Practice location:
  • Phone: 570-808-7916
  • Fax:
Mailing address:
  • Phone: 570-561-5358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.008864RX
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA066524
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: