Provider Demographics
NPI:1225743354
Name:WACKER, ANNE ELLEN (PA-C)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:ELLEN
Last Name:WACKER
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 1:118 N LYNBROOK DR
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-0270
Mailing Address - Country:US
Mailing Address - Phone:704-763-1691
Mailing Address - Fax:
Practice Address - Street 1:711 NEW LEICESTER HWY
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-1048
Practice Address - Country:US
Practice Address - Phone:828-253-3717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-12745363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant