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General NPI Number Information
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NPI Number | 1538866215
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Entity Type | Individual
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Provider Name | LIZMEIDY HERNANDEZ PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/13/2023
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 1000 E MOUNTAIN BLVD
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City | WILKES BARRE
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State | PA
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Zip | 18711-0027
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Country | US
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Telephone | 570-808-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 241 S FULTON CT
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City | HAZLETON
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State | PA
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Zip | 18201-7268
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Country | US
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Telephone | 570-497-6330
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Fax |
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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 | MA064831
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License Number State | NULL
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