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General NPI Number Information
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NPI Number | 1558983148
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Entity Type | Individual
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Provider Name | LANA CAROLINE HOERTZ PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/18/2020
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Last Update Date | 12/09/2021
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Provider Practice Location Address
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Address Line | 118 NORTHPORT AVE
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City | BELFAST
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State | ME
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Zip | 04915-6072
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Country | US
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Telephone | 207-505-4123
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Fax |
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Provider Business Mailing Address
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Address Line | 43 WHITING HILL RD STE 300
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City | BREWER
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State | ME
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Zip | 04412-1006
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2069
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License Number State | ME
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