Provider Demographics
NPI:1598744849
Name:WOLFE, HEATHER LOUISE (PA-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LOUISE
Last Name:WOLFE
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 1:785 5TH AVENUE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-217-4217
Practice Address - Street 1:2 KEEFER DR
Practice Address - Street 2:
Practice Address - City:MERCERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17236-1732
Practice Address - Country:US
Practice Address - Phone:717-328-2119
Practice Address - Fax:717-328-0071
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052432363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103182151Medicaid
PA25-1716306OtherHEALTHNET/TRICARE
PA443698OtherHEALTH AMERICA
PAMA052432OtherPA LICENSE
PAP00602493OtherRAILROAD MEDICARE
PA867633OtherMEDICARE GROUP #
PA50074553OtherCAPITAL BLUECROSS
PA50074553OtherCAPITAL BLUECROSS
PA099838LN7Medicare PIN