Provider Demographics
NPI:1952326530
Name:HEDRICK, LISA K (PA)
Entity Type:Individual
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First Name:LISA
Middle Name:K
Last Name:HEDRICK
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:621 S ILLINOIS AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-5489
Mailing Address - Country:US
Mailing Address - Phone:641-494-3041
Mailing Address - Fax:641-494-3059
Practice Address - Street 1:1000 4TH ST SW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2800
Practice Address - Country:US
Practice Address - Phone:641-422-6999
Practice Address - Fax:641-422-6678
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2021-04-20
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Provider Licenses
StateLicense IDTaxonomies
IA001050363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAS25793Medicare UPIN