Provider Demographics
NPI:1346351210
Name:HAND, LIESL M (PA)
Entity Type:Individual
Prefix:MS
First Name:LIESL
Middle Name:M
Last Name:HAND
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:LIESL
Other - Middle Name:M
Other - Last Name:HERMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:125 LATTIMORE ROAD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-4155
Mailing Address - Country:US
Mailing Address - Phone:585-442-2075
Mailing Address - Fax:585-244-4298
Practice Address - Street 1:121 ERIE CANAL DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4605
Practice Address - Country:US
Practice Address - Phone:585-225-5420
Practice Address - Fax:585-225-4644
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008321363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P89445Medicare UPIN
PA1627Medicare PIN
NYDD5691Medicare ID - Type Unspecified