Healthcare Provider Details

I. General information

NPI: 1285700807
Provider Name (Legal Business Name): HEATHER GERSBACHER HAZLETT RPA C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER ANN GERSBACHER RPA C

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MONUMENT RD SUITE 290
YORK PA
17403-5060
US

IV. Provider business mailing address

1803 MOUNT ROSE AVE SUITE B3
YORK PA
17403-3026
US

V. Phone/Fax

Practice location:
  • Phone: 717-812-4090
  • Fax: 717-812-4092
Mailing address:
  • Phone: 717-851-1405
  • Fax: 717-812-4092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number006869
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number006869
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA053963
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA053963
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMA053963
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: