Provider Demographics
NPI:1346496700
Name:HEKMAN, ALIZA LAUREN (PA-C)
Entity Type:Individual
Prefix:
First Name:ALIZA
Middle Name:LAUREN
Last Name:HEKMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALIZA
Other - Middle Name:LAUREN
Other - Last Name:BRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1381 WESTGATE CENTER DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2934
Practice Address - Country:US
Practice Address - Phone:336-718-0440
Practice Address - Fax:336-718-0441
Is Sole Proprietor?:No
Enumeration Date:2008-08-16
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-01464363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2762405Medicare PIN