Provider Demographics
NPI:1225025505
Name:HISERMAN, HELEN O (PA-C)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:O
Last Name:HISERMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HELEN
Other - Middle Name:M
Other - Last Name:OVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1201 GRAMPIAN BLVD
Mailing Address - Street 2:STE 3A
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1900
Mailing Address - Country:US
Mailing Address - Phone:570-322-4025
Mailing Address - Fax:570-322-6403
Practice Address - Street 1:1201 GRAMPIAN BLVD
Practice Address - Street 2:STE 3A
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-1900
Practice Address - Country:US
Practice Address - Phone:570-322-6450
Practice Address - Fax:570-322-0648
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001599L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
052829Medicare ID - Type Unspecified
S50724Medicare UPIN