Provider Demographics
NPI:1497283030
Name:HLAVINKA, PAUL W (CRNP)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:W
Last Name:HLAVINKA
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 BRODHEAD RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-8931
Mailing Address - Country:US
Mailing Address - Phone:484-526-3218
Mailing Address - Fax:484-526-3180
Practice Address - Street 1:153 BRODHEAD RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-8931
Practice Address - Country:US
Practice Address - Phone:484-526-3218
Practice Address - Fax:484-526-3180
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017592363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPENDINGMedicaid