Provider Demographics
NPI:1417036492
Name:HUGHES, MARISA LEE (PA C)
Entity Type:Individual
Prefix:MRS
First Name:MARISA
Middle Name:LEE
Last Name:HUGHES
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
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Mailing Address - Street 1:166 SAXER AVENUE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064
Mailing Address - Country:US
Mailing Address - Phone:610-328-7262
Mailing Address - Fax:610-328-4440
Practice Address - Street 1:166 SAXER AVE
Practice Address - Street 2:SPRINGFIELD SPORT EMERGENCY MEDICAL CORP
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064
Practice Address - Country:US
Practice Address - Phone:610-328-7262
Practice Address - Fax:610-328-4440
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PA0A002059363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant