Provider Demographics
NPI:1194550657
Name:LIUZZO, KAMRYN (PA-C)
Entity type:Individual
Prefix:
First Name:KAMRYN
Middle Name:
Last Name:LIUZZO
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 1:2877 DEVONSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-8582
Mailing Address - Country:US
Mailing Address - Phone:570-561-5358
Mailing Address - Fax:
Practice Address - Street 1:3286 PENTAGON BLVD # 10
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-1789
Practice Address - Country:US
Practice Address - Phone:937-490-6571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.008864RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant