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NPI Code Detail

MEDICARE: MRS. HOLLY ELIZABETH RAIMONDI PA-C

MEDICARE: MRS. HOLLY ELIZABETH RAIMONDI 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
1363AS0400XSurgical Physician Assistant10000619AIN

General Provider Information

NPI Number : 1093710105
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. HOLLY ELIZABETH RAIMONDI PA-C
Provider Business Mailing Address
First Line : 1400 S LAKE PARK AVE
Second Line : STE 200
City : HOBART
State : IN
Zip : 46342-6791
Country : US
Telephone Number : 219-947-6122
Fax Number : 219-947-6045
Provider Business Practice Location Address
First Line : 1400 S LAKE PARK AVE
Second Line : STE 200
City : HOBART
State : IN
Zip : 46342-6791
Country : US
Telephone Number : 219-947-6122
Fax Number : 219-947-6045
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2005
Last Update Date : 06/16/2011

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Directions to “ MRS. HOLLY ELIZABETH RAIMONDI PA-C” Practice Location

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