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NPI Code Detail

MEDICARE: LISA M HEBL PA-C

MEDICARE:   LISA M HEBL  PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant9526MN
2363A00000XPhysician Assistant9526MN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2970018168OTHERMNRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003808023
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA M HEBL PA-C
Provider Business Mailing Address
First Line : 6351 E SUPERIOR ST
Second Line :
City : DULUTH
State : MN
Zip : 55804-2545
Country : US
Telephone Number : 218-249-4500
Fax Number : 218-249-4555
Provider Business Practice Location Address
First Line : 6351 E SUPERIOR ST
Second Line :
City : DULUTH
State : MN
Zip : 55804-2545
Country : US
Telephone Number : 218-249-4500
Fax Number : 218-249-4555
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2005
Last Update Date : 12/16/2020

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Directions to “ LISA M HEBL PA-C” Practice Location

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