Provider Demographics
NPI:1477226991
Name:WIMER, OLIVIA (PA-C)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:WIMER
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 1:123 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DUBOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1409
Mailing Address - Country:US
Mailing Address - Phone:814-594-1440
Mailing Address - Fax:814-503-8568
Practice Address - Street 1:123 HOSPITAL AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:DUBOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1409
Practice Address - Country:US
Practice Address - Phone:814-371-1900
Practice Address - Fax:814-503-8568
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA005722363AS0400X, 363A00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology