Basic Information
Provider Information
NPI: 1073147435
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HINKEL
FirstName: ELIZABETH
MiddleName: ANN
NamePrefix: MS.
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 7527
Address2:  
City: DUBLIN
State: OH
PostalCode: 430170727
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1040 DELAWARE AVE
Address2:  
City: MARION
State: OH
PostalCode: 433026416
CountryCode: US
TelephoneNumber: 7403837950
FaxNumber: 7403758164
Other Information
ProviderEnumerationDate: 02/25/2020
LastUpdateDate: 12/08/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/08/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X50.006312RXOHY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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