1487810511 NPI number — PATRICIA LYNN WILLAUER HERTZ PA-C

Table of content: PATRICIA LYNN WILLAUER HERTZ PA-C (NPI 1487810511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487810511 NPI number — PATRICIA LYNN WILLAUER HERTZ PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERTZ
Provider First Name:
PATRICIA
Provider Middle Name:
LYNN WILLAUER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487810511
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
136 LINDEN DR STE 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINCHESTER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22601-6900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-678-3588
Provider Business Mailing Address Fax Number:
540-678-9025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 S CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERRYVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22611-1369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-955-4811
Provider Business Practice Location Address Fax Number:
540-955-0976
Provider Enumeration Date:
07/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  0110002828 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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