Provider Demographics
NPI:1952027567
Name:LEYMEISTER, LILY GRACE (PA-C)
Entity type:Individual
Prefix:
First Name:LILY
Middle Name:GRACE
Last Name:LEYMEISTER
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 1:37 HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:PA
Mailing Address - Zip Code:17922-9094
Mailing Address - Country:US
Mailing Address - Phone:570-640-2578
Mailing Address - Fax:
Practice Address - Street 1:251 E BRINGHURST ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-1799
Practice Address - Country:US
Practice Address - Phone:215-844-1020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-14
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA064110363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical