Healthcare Provider Details

I. General information

NPI: 1487810511
Provider Name (Legal Business Name): PATRICIA LYNN WILLAUER HERTZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 06/25/2023
Certification Date: 06/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 S CHURCH ST
BERRYVILLE VA
22611-1369
US

IV. Provider business mailing address

136 LINDEN DR STE 104
WINCHESTER VA
22601-6900
US

V. Phone/Fax

Practice location:
  • Phone: 540-955-4811
  • Fax: 540-955-0976
Mailing address:
  • Phone: 540-678-3588
  • Fax: 540-678-9025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110002828
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: