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General NPI Number Information
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NPI Number | 1023268505
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Entity Type | Individual
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Provider Name | LISA M. TKACHENKO PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/22/2008
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Last Update Date | 07/31/2024
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Provider Practice Location Address
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Address Line | 410 N KROCKS RD
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City | ALLENTOWN
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State | PA
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Zip | 18106-9283
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Country | US
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Telephone | 888-982-8594
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Fax | 888-920-1525
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Provider Business Mailing Address
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Address Line | PO BOX 159
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City | BARRINGTON
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State | NJ
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Zip | 08007-0159
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Country | US
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Telephone | 484-884-4500
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Fax | 484-884-0699
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA053629
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License Number State | PA
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