Basic Information
| Provider Information | |||||||||
| NPI: | 1598744849 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOLFE | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | LOUISE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVENUE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7172174217 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 KEEFER DR | ||||||||
| Address2: | |||||||||
| City: | MERCERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172361732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173282119 | ||||||||
| FaxNumber: | 7173280071 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2006 | ||||||||
| LastUpdateDate: | 11/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | MA052432 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | MW1212416 | 01 | PA | DEA | OTHER | 103182151 | 05 | PA | MEDICAID | 25-1716306 | 01 | PA | HEALTHNET/TRICARE | OTHER | 443698 | 01 | PA | HEALTH AMERICA | OTHER | MA052432 | 01 | PA | PA LICENSE | OTHER | P00602493 | 01 | PA | RAILROAD MEDICARE | OTHER | 867633 | 01 | PA | MEDICARE GROUP # | OTHER | 50074553 | 01 | PA | CAPITAL BLUECROSS | OTHER |