Provider Demographics
NPI:1669549788
Name:HEMAK, HEIDI (PA-C)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:
Last Name:HEMAK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 JEFFERSON AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1636
Mailing Address - Country:US
Mailing Address - Phone:570-558-0182
Mailing Address - Fax:570-558-0183
Practice Address - Street 1:743 JEFFERSON AVE STE 104
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1636
Practice Address - Country:US
Practice Address - Phone:570-558-0182
Practice Address - Fax:570-558-0183
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002763-L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P60869Medicare UPIN
058643Medicare ID - Type Unspecified