MEDICARE: ALEXA MARIE HETZEL 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
1	363A00000X	Physician Assistant	25MP00479400	NJ

General Provider Information

NPI Number	:	1851887301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXA MARIE HETZEL PA-C

Provider Business Mailing Address
First Line	:	59 ONE MILE RD EXT
Second Line	:
City	:	EAST WINDSOR
State	:	NJ
Zip	:	08520-2505
Country	:	US
Telephone Number	:	609-443-4500
Fax Number	:

Provider Business Practice Location Address
First Line	:	59 ONE MILE RD EXT
Second Line	:
City	:	EAST WINDSOR
State	:	NJ
Zip	:	08520-2505
Country	:	US
Telephone Number	:	609-443-4500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2018
Last Update Date	:	07/09/2018

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