1508143215 NPI number — MS. ALLISON MARY WOLFE PA-C

Table of content: MS. ALLISON MARY WOLFE PA-C (NPI 1508143215)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508143215 NPI number — MS. ALLISON MARY WOLFE PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLFE
Provider First Name:
ALLISON
Provider Middle Name:
MARY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROHRER
Provider Other First Name:
ALLISON
Provider Other Middle Name:
MARY
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1508143215
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
81 CLARION RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOHNSONBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15845-1656
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-389-4411
Provider Business Mailing Address Fax Number:
814-389-4142

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
81 CLARION RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSONBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15845-1656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-389-4411
Provider Business Practice Location Address Fax Number:
814-389-4142
Provider Enumeration Date:
11/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  MA055175 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MA055175 . This is a "COMMONWEALTH OF PENNSYLVANIA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: OA003213 . This is a "PA OSTEOPATHIC BOARD OF MEDICINE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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