Provider Demographics
NPI:1336879527
Name:HASSKAMP, LISHA (PA)
Entity Type:Individual
Prefix:
First Name:LISHA
Middle Name:
Last Name:HASSKAMP
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:126 E DAOG CT
Mailing Address - Street 2:
Mailing Address - City:DEDEDO
Mailing Address - State:GU
Mailing Address - Zip Code:96929-5527
Mailing Address - Country:US
Mailing Address - Phone:671-787-5252
Mailing Address - Fax:
Practice Address - Street 1:1088 W MARINE CORPS DR STE 239
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929-5553
Practice Address - Country:US
Practice Address - Phone:671-637-2873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-12
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant