Basic Information
| Provider Information | |||||||||
| NPI: | 1508143215 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOLFE | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | MARY | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ROHRER | ||||||||
| OtherFirstName: | ALLISON | ||||||||
| OtherMiddleName: | MARY | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PA-C | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 81 CLARION RD | ||||||||
| Address2: | |||||||||
| City: | JOHNSONBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 158451656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8143894411 | ||||||||
| FaxNumber: | 8143894142 | ||||||||
| Practice Location | |||||||||
| Address1: | 81 CLARION RD | ||||||||
| Address2: | |||||||||
| City: | JOHNSONBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 158451656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8143894411 | ||||||||
| FaxNumber: | 8143894142 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2011 | ||||||||
| LastUpdateDate: | 01/07/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | MA055175 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | MA055175 | 01 | PA | COMMONWEALTH OF PENNSYLVANIA | OTHER | OA003213 | 01 | PA | PA OSTEOPATHIC BOARD OF MEDICINE | OTHER |