Individual
LISA M HEBL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6351 E SUPERIOR ST, DULUTH, MN 55804-2545
(218) 249-4500
(218) 249-4555
Mailing address
6351 E SUPERIOR ST, DULUTH, MN 55804-2545
(218) 249-4500
(218) 249-4555
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9526
MN
363AM0700X
Medical Physician Assistant
9526
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104337400
—
MN
01
—
970018168
RAILROAD MEDICARE
MN
Enumeration date
08/16/2005
Last updated
12/16/2020
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