Provider Demographics
NPI:1053840603
Name:LIZZA, HELEN YANTA (PA)
Entity Type:Individual
Prefix:MS
First Name:HELEN
Middle Name:YANTA
Last Name:LIZZA
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-273-3376
Mailing Address - Fax:888-665-8309
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:DIV IM DERMATOLOGY, STE 2A AND 2D
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-273-3376
Practice Address - Fax:888-665-8309
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2024-04-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2019017054363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO220077087Medicaid