Provider Demographics
NPI:1598025025
Name:HACKETT, LIA (APN)
Entity Type:Individual
Prefix:MS
First Name:LIA
Middle Name:
Last Name:HACKETT
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PATERSON AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432-1829
Mailing Address - Country:US
Mailing Address - Phone:201-321-4071
Mailing Address - Fax:
Practice Address - Street 1:11 PATERSON AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1829
Practice Address - Country:US
Practice Address - Phone:201-321-4071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00377100363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health