Provider Demographics
NPI:1093072670
Name:OLAYIWOLA, AMY R (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:R
Last Name:OLAYIWOLA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:R
Other - Last Name:ZABROSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:1533 COMMERCE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015-9128
Mailing Address - Country:US
Mailing Address - Phone:717-960-8956
Mailing Address - Fax:717-218-7557
Practice Address - Street 1:1533 COMMERCE AVE STE 2
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-9128
Practice Address - Country:US
Practice Address - Phone:717-960-8956
Practice Address - Fax:717-218-7557
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055791363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA446636FLTMedicare PIN
PAPENDINGMedicare PIN
PAP01572212Medicare PIN